REPORT 



Special Milk Board 



Massachusetts State Department of Health. 



Submitted to the Commissioner of Health and Public 
Health Council December 29, 1915. 




BOSTON: 

WRIGHT & POTTER PRINTING CO., STATE PRINTERS, 

32 DERNE STREET. 

1916. 




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Book. Mf S* 



REPORT 



Special Milk Board fj^ 



Massachusetts State Depaetment of Health. 
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Submitted to the Commissioner of Health and Public 
Health Council December 29, 1915. 




BOSTON: 

WEIGHT & POTTER PRINTING CO., STATE PRINTERS, 

32 DERNE STREET. 

1916. 



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'0.' of D. 

JAN 19 1917 



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State Department of Health, Boston, Dec. 29, 1915. 
To the Commissioner of Health and Public Health Council. 

Gentlemen: — The Special Board of this Department ap- 
pointed to investigate the status of milk production, distribu- 
tion and inspection, and the relation thereof to the public 
health of this Commonwealth, by an order of the Commissioner 
of Health of March 29, 1915, has the honor to present here- 
with the accompanying report. 

Respectfully submitted, 

EUGENE R. KELLEY, Chairman, 
JOSEPH E. LAMOUREUX, 
HERMANN C. LYTHGOE, 
EDWARD H. WILLIAMS, Recorder, 

Members of the Board. 



TABLE OF CONTENTS. 



c. 

D. 



B. 



D. 

E. 



G. 



H. 



B. 



C. 



D. 



A. 

B. 
C. 



Williams, 



Preface, by Allan J. McLaughlin, 
Introduction, 
Abstract of Report, . 
Conclusions, . . . 

Part I. Historical, 

A.» Development of Present Milk Controversy, by Edward H 

B. Earlier Investigations, by Dr. Eugene R. Kelley, 

1. Legislative Inquiry of 1910, 

2. Special Milk Commission of 1910, 

3. Boston Chamber of Commerce Investigation of 1915, 
Summary of Proposed Laws relating to Milk, by Dr. Lewis Fish, 1 
Summary of Present Milk Laws, by Hermann C. Lythgoe, 

Part II. Statements of Various Interests, .... 
A. Milk Contractors, compiled by Hermann C. Lythgoe, 

Boston Chamber of Commerce, by John C. Orcutt, Assistant Secre 
tary, , 

Milk Consumers' League, by Myron L. Pierce, Council of Milk Con- 
sumer's League, ........ 

The State Grange, by Hon. Chas. M. Gardner, 

Milk and Baby Hygiene Associations, by Dr. J. Herbert Young 
Medical Director, Boston Milk and Baby Hygiene Association, 

City of Boston Health Department, by Dr. Francis X. Mahoney, 
Health Commissioner, ...... 

Massachusetts State Board of Agriculture, by Wilfrid Wheeler 
Secretary, 

Massachusetts State Department of Animal Industry, by Dr. Lester 
H. Howard, Commissioner, ..... 

I. Cattle Breeders' Associations, compiled by Edward H. Williams, 
Part III. Facts of Production, Processing and Marketing, 

A. Summary of Milk Board's Own Dairy Inspections, ■ by Dr. Lewis 
Fish, 

Compilation of Milk Contractor's Statements, by Dr. Eugene R 
Kelley and Hermann C. Lythgoe, ..... 

Observations on Past and Present Increase, Decrease, Fluctuations 
and Geographical Movements of Commercial Milk and Cream 
Production in Massachusetts and Neighboring States and the 
Province of Quebec in Relation to the Milk Supply of this Com- 
monwealth, by Edward H. Williams, 

The Commercial Pasteurization of Milk and Cream, by Hermann C. 
Lythgoe, . . . . . . . .. i . 

Part IV. Facts of the Present Official Supervision of the Milk 
Supply of this Commonwealth, by Hermann C. Lythgoe, . 

Present Status of Official Supervision of the Massachusetts Milk 
Supply by Federal, State and Local Authorities 

Present Status of Local Milk Inspection, 

Discussion of Present System of Dairy Inspection and its Sanitary 
Value, ...... 



PAGE 

9 
11 
13 

22 
27 
27 
29 
30 
31 
32 
33 
37 
42 
42 

46 

47 
49 

51 

52 

53 

55 
58 
60 

60 

73 



77 
105 

iio 
no 

117 
121 



> Proposed laws for 1914 summarized by E. H. Williams. 



PAGE 

Paet V. The Relationship between Cow's Milk and the Public 
Health, by Dr. Eugene R. Kelley, Dr. Lewis Fish and Dr. John 
S. Hitchcock 126 

A. Introduction, by Dr. Eugene R. Kelley, . . . . . 126 

B. Milk and the Communicable Diseases, ...... 128 

1. Milk and Tuberculosis, by Dr. Eugene R. Kelley, . . . 128 

2. Methods of Infection of Milk by Diphtheria, Scarlet Fever, Septic 
Sore Throat and Typhoid Fever, by Dr. Lewis Fish, . . . 135 

3. Communicable Diseases of Minor Significance or Relative Id- 
frequency, in which Milk is concerned as an Agent of Transmission, 

by Dr. Eugene R. Kelley, ........ 137 

4. The Evidence Available as to the Relative Importance of Milk 
as a Means of Transmission of Communicable Diseases, compared 
with Other Means of Transmission, by Dr. Eugene R. Kelley, 138. 

5. The Possible Means of preventing Communicable Disease Trans- 
mission through Milk, and their Relative Practicability, by Dr. 
Eugene R. Kelley, ......... 166 

6. Pasteurization as a Means of Infectious Disease Prevention, by 

Dr. Eugene R. Kelley, " . . .168 

C. Milk and Infant Mortality, by Dr. John S. Hitchcock, . . .172 

D. The Nutritional Value of Milk, by Dr. John S. Hitchcock, . . 185 
Pabt VI. Grading of Milk, by Hermann C. Lythgoe, .... 190 

A. General Discussion, . . . . . . . . .190 

B. Relation between Solids and Fats in Milk, ..... 200 
Part VII. Experiences op Other Localities, ..... 206 

A. Report on an Investigation of the New York City Milk Grading 

System in the City of New York, by Hermann C. Lythgoe, . . 2 n 6 

B. Report on a Special Investigation of the Efficiency of the New York 

GradiDg System in the Producing Area, by Clarence E. Marsh, . 214 

C. Report on a Special Investigation of the New York Grading System 

in the Producing Area, by Charles H. Hickey, . . . .216 

D. Copy of an Article by Lucius P. Brown of the New York City Health 

Department, .......... 220 

E. Report on Information gathered at the Convention of the Inter- 

national Milk Inspectors Association, by Clarence E. Marsh, . 230 

F. Digest of Recent American Milk Legislation by Various Cities and 

States, by Dr. Lewis Fish, . . 233 



LIST OF APPENDICES. 



A. — Tabulation of Answers to Questionnaire on Milk and Disease for the 

Years 1909-13, . . .238 

B. — Forms of Questionnaire and Letters sent to Local Boards of Health, 

and a List of Cities and Towns failing to reply to Question- 
naire, . . . . . . . ... . 249 

C. — Abstract of Milk-borne Epidemics in Massachusetts from 1906-15, . 252 

D. — Copy of Letter sent to, and replies from, Epidemiological Authorities 

of Other States relative to Milk and Disease, . . . 262 

E. — Influence of Pasteurization on Chemical Content of Milk, . . . 273 

F. — Status of Local Milk Inspection: — 293 

(a) Summary of Local Milk Inspection, classified by Cities and 

Towns, 297 

(b) Summary of Local Milk Inspection, alphabetically, . . . 321 

G. — Statistics of Milk Transportation into Boston, ..... 339 

H. — Replies to Questionnaire relative to Local Milk Inspection, . . 344 

I. — Map showing Places inspected by the Milk Board, .... 353 

J. — Bibliography, .......... 354 

K. — List of Conferences and Meetings attended, or of Persons interviewed, 

relative to the Milk Question, ...... 356 



PREFACE. 



The writer became Commissioner of Health in November, 
1914, and within a week he was importuned by several factors 
in the milk problem to take sides and give testimony for or 
against certain proposed legislation. The milk problem in 
Massachusetts had agitated the people for years, and had 
degenerated into an acrimonious controversy which made it 
difficult to separate easily real facts from mere assertions. 

Milk problems exist everywhere, and the subject was not 
new to me as a health officer, but I felt that conditions in 
Massachusetts were different from other States, and that it 
would be unwise and unfair to apply general knowledge of a 
problem without a careful study of local conditions and their 
bearing on the problem. I felt that I had a right to proceed 
one year at least under existing law, and to utilize that time 
in informing myself as to the dairy industry in Massachusetts. 

After a year's study, a fair impartial report with recommen- 
dations could be made from facts collected by an unbiased 
board. Accordingly, I appointed a Board to secure the facts 
in the dairy industry in Massachusetts, with instructions to 
extend their investigations to adjoining States and the Province 
of Quebec. I knew that without a special appropriation this 
could be done by this Department, but that it would involve 
much overtime work and considerable self-sacrifice on the part 
of the Board. The personnel of the Board was as follows: — 

Dr. Eugene R. Kelley, Director of the Division of Communicable Dis- 
eases, formerly Commissioner of Health of the State of Washington, and 
a sanitarian of wide experience. 

Mr. Hermann C. Lythgoe, Director of the Division of Food and Drugs, 
in charge of both the inspection and laboratory work of the Department 
in connection with milk, an analyst and chemist with a most thorough 
knowledge of all phases of the milk problem. 

Mr. Edward H. Williams, a practical farmer and dairyman, an assistant 
in the Division of Sanitary Engineering of the Department, who was 



10 

selected because of his knowledge of farming conditions in the State, and 
especially with those conditions related to or dependent upon the milk 
industry. 

As a representative of the Public Health Council, Dr. J. E. Lamoureux 
was appointed, a practicing physician of high standing, an excellent sani- 
tarian, and the possessor of an analytical and judicial mind. 

These gentlemen worked overtime, Sundays and holidays, 
and sacrificed vacations and other privileges, in order to carry 
on the work, but returned with all the available data touching 
our milk problem. With such a committee I feel sure not only 
that we have the facts, but that they are presented fairly with- 
out bias, and with only one object, viz.: to furnish a solution 
for the milk problem and to take it out of politics and out of 
controversy for all time. 



REPORT OF SPECIAL MILK BOARD OF THE MASSA- 
CHUSETTS STATE DEPARTMENT OF HEALTH. 



INTRODUCTION. 

The special Milk Board of the State Health Department 
was appointed by the State Commissioner of Health on March 
29, 1915. It was charged with the duty of collecting all avail- 
able facts relative to the milk problem of this Commonwealth 
for the guidance of the Commissioner and Public Health Coun- 
cil in drafting legislation to be submitted to the General Court 
if it should appear from the results of such investigation that 
new legislation was desirable. 

Originally it was intended to confine this investigation to the 
public health aspects of milk production and distribution. 
Because of the closely interwoven connection between the 
economic and sanitary features of the milk problem your Board 
soon found that such a procedure was impossible, and we have, 
therefore, endeavored to cover the entire problem in a com- 
prehensive manner. 

The report is seriously incomplete from one important stand- 
point, — the total number of producing dairies personally 
visited by members of your Board. We estimate that in all we 
have seen possibly 2 per cent, of the producing farms supplying 
milk to Massachusetts consumers. As far as possible we have 
endeavored to select typical sections, and feel that in reality we 
have by this procedure obtained a much truer picture of aver- 
age dairy conditions than if we had concentrated our visits in a 
smaller area and possibly visited a considerably higher per- 
centage of the total producing dairies. 

The report has become voluminous under our hands to a 
degree neither anticipated nor desired, but the entire problem 
presents so many ramifications that we felt we could not in 



12 

justice to the question omit any of the included subject-matter. 
In fact, many bulky sections of the report are in reality very 
condensed abstracts of the total data consulted. 

Throughout the progress of the report your Board has been 
indebted to the courteous co-operation of many officials and 
private citizens. A partial list of these persons is given in 
Appendix K, and we will not attempt to enumerate them all 
here. 

Special mention should be made, however, of the assistance 
given by the personnel of the Food and Drug Division of the 
State Department of Health, including both inspectors, ana- 
lysts and clerical force. To them we owe the collection of data 
from local boards of health. 

Two of the State district health officers, Dr. Lewis Fish and 
Dr. John S. Hitchcock, have in effect served as members of 
the Board. Several sections of the report have been contrib- 
uted by them, and they have, in addition, carried out pains- 
taking investigations into the general literature of milk and the 
epidemiological records of this Department. Other district 
health officers, notably Dr. Jones, have assisted your Board in 
carrying out dairy inspections. 

To many city and town health officials within the Common- 
wealth, as well as to epidemiological authorities of other States, 
and of the Federal Public Health Service, we are deeply indebted 
for valuable information, suggestions and criticisms. 

Special acknowledgment is due the following for careful 
criticism of various finished sections of the report: — 

Dr. Charles V. Chapin, Superintendent of Health of Providence, 
R.I. 

Dr. Mark W. Richardson, Former Secretary, Massachusetts State 
Board of Health. 

Dr. Thomas B. Shea, Director, Division of Communicable Diseases, 
Boston City Health Department. 

Dr. A. J. Chesley, Director, Division of Preventable Diseases, Minne- 
sota State Board of Health. 

All of these gentlemen critically reviewed Part V. of the 
report as to authenticity, fairness and reasonableness of the 
epidemiological deductions contained therein. 



13 

In a similar manner, special acknowledgment is due the 
following gentlemen: — 

Hon. Wilfrid Wheeler, Secretary, State Board of Agriculture. 

Mr. J. C. Orcutt, Assistant Secretary, Boston Chamber of Commerce. 

Mr. P. M. Harwood, Agent of the State Dairy Bureau. 

Hon. Chas. M. Gardner, Member of State Dairy Bureau. 

Hon. William D. T. Trefry, State Tax Commissioner. 

These gentlemen all contributed many facts and statistics 
relative to present and past production of milk. 

ABSTRACT OF REPORT OF MILK BOARD. 

The progress of this investigation revealed such a mass of 
facts and opinions bearing upon the present milk problem of 
Massachusetts that the inclusion of simply the most pertinent 
material made this report voluminous to an extent not antici- 
pated. We have therefore deemed it wise, for the benefit of 
those who do not care to go into the detail of the subject, to 
prepare a brief abstract of the report for inclusion at this 
point. 

The report is divided into conclusions, the main body of the 
report and appendices. The conclusions, which immediately 
follow this abstract, cannot be further summarized. The report 
proper is divided into seven parts. 

PART I. 
Section A. 

In this section it is first pointed out that there has been 
friction between the producers, middlemen and transportation 
interests for at least twenty years. In addition to this source of 
irritation such things as overlapping laws, imposing practically 
the same powers and duties upon the State Boards of Health 
and Agriculture and local boards of health, overlapping and at 
times contradictory systems of dairy inspections by State and 
local health officials, extreme statements from all parties con- 
cerned as to the relative weight of different sanitary and eco- 
nomic aspects of the problem, have all contributed to the 



14 

development of the bitter controversial spirit that has been so 
widely manifested relative to the entire subject of production 
and sanitary supervision of milk in the Commonwealth during 
the past six years. 

Section B. 

Three special investigations, two legislative and one non- 
official (that of the Boston Chamber of Commerce), have added 
materially to the information available upon the subject, but 
cannot be said to have produced any definite results except the 
introduction of much proposed legislation into the General 
Court. 

Section C. 

The laws proposed for the solution of the milk problem of 
the Commonwealth are in general agreement in providing for 
the abolition of certain features of the present system of local 
control and the substitution of a central State inspection board 
with plenary powers. The controversies have all arisen over 
the manner in which such central board shall be appointed 
and controlled. 

Section D. 

It is not possible to summarize this section any further. 

PART II. 

In this part an attempt has been made to gather author- 
itative statements from various persons and interests con- 
cerned in the milk question. In general, these may be said to 
fall into three groups. 

Group A. — Dairy and agricultural interests, comprising the State 
Grange, the State Board of Agriculture, the State Department of Animal 
Industry and the cattle breeders' associations. 

Group B. — Those concerned in the business aspects of the question, 
viz., the milk dealers and the Boston Chamber of Commerce. 

Group C. — Those interested in milk from the health standpoint, 
viz., the Milk Consumers' League, the Boston Department of Health 
and the Milk and Baby Hygiene Associations. 

The general contention of Group A is that agitation and at- 
tempted legislation have had only detrimental effect on the 



15 

milk industry. Natural economic conditions, such as increase 
in land values, increase in transportation facilities, and more 
remunerative returns from other lines of agriculture have tended 
to drive milk production out of the State. In addition to this 
there is a general feeling that the attitude and statements of 
the so-called clean milk advocates has had a positive detrimen- 
tal influence on the milk business, and has hastened the' opera- 
tion of these economic conditions. This group offers no re- 
medial suggestions. The cattle breeders' associations, with the 
exception of the Holstein Breeders Association, in answer to 
a direct question submitted by your Board, believe that the 
price of milk should be governed by the fat content. The 
Grange believes that the farmers can and will produce a better 
article if they receive a better price. 

The general contention of Group B is that the present sys- 
tem of distribution of milk cannot be greatly improved upon, 
but that the competition between retail dealers is disastrous to 
the financial aspects of the business, and the lack of a standard- 
ized or graded product does not tend to improve the situation. 
Some of this group seem to be of the opinion that official in- 
spection should be centralized, and should be administered 
preferably by the State Department of Health. 

In some respects the members of Group C are in accord with 
some of the contentions of Group B. The Health Department 
of the city of Boston believes that the city is being very un- 
justly practically forced to carry nearly all the expense inci- 
dental to milk inspection for most of the other cities and towns 
comprising greater Boston, and for this reason are strongly in 
favor of this duty being transferred to some State authority. 
The Massachusetts Milk Consumers' League, to use their own 
words, state: "The Association has never taken any arbitrary 
position as to the form of the bill, only insisting on the central 
principle that the State Department of Health should have 
legal power on its own initiative in places where milk is pro- 
duced or handled, to insist upon reasonable cleanliness." 



16 

PART III. 
Section A. 

As this section is itself merely a summary of the conditions 
noted in the various trips of inspection made by the members 
of the Milk Board, it is difficult to emphasize its findings any 
further, but the general impression received was, although 
many individual and geographical exceptions to the rule were 
found, that producing dairies in Massachusetts were, on the 
whole, in very satisfactory sanitary condition, which impres- 
sion is substantiated by the records of routine dairy inspec- 
tions made by the State Department of Health. Typical 
dairies in Maine, New Hampshire, Vermont and Quebec sup- 
plying Massachusetts markets are, on the whole, somewhat 
below the sanitary standards of Massachusetts dairies. 

Section B. 

This section is a portion of the summary of replies received 
to a questionnaire submitted to contractors. It deals with the 
phases of production and of distribution of their milk supply 
and gives a summary of their methods of dairy inspection. 

Section C. 

This section deals with the production of milk in Massa- 
chusetts and neighboring States and the province of Quebec, 
and its increase, decrease and geographical fluctuations. Milk 
production in Massachusetts has steadily decreased while the 
population has increased. In this section the following points 
are discussed: variation in number of milch cattle kept in 
Massachusetts from 1890 to date, supplemented by evidence of 
freight statistics of the milk brought into greater Boston; 
effects of the increasing cost of producing milk in Massachu- 
setts, and its comparison with the cost of milk production in 
other States and Quebec; the relative importance of dairying 
to diversified farming; the fact that beside the use of milk raw 
and for cooking purposes the steadily increasing consumption 
of cream, butter, cheese and ice cream accounts for a large 
proportion of the total milk consumed; the use of the by- 
products of milk, particularly of casein in the arts and sciences, 



17 

and the fact that this is a relatively unappreciated but im- 
portant use of cow's milk; causes assigned by various inter- 
ested parties for the decrease in milk production, the principal 
ones alleged being oppressive activities of the State and local 
boards of health in carrying out dairy inspection, the exag- 
gerated newspaper publicity relative to milk epidemics and 
alleged epidemics, constant legislative agitation, the increasing 
use of evaporated, powdered and condensed milks brought in 
from long distances, lower prices offered to the producer, the 
development of more remunerative and less laborious forms of 
agriculture, together with increasing scarcity of farm labor; 
several pages are devoted to the actual cost of keeping cows 
and producing milk, according to best statistics available; the 
average amount of milk production per cow in Massachusetts 
and neighboring States; salient points obtained by interviews 
with agents of condensed, powdered and evaporated milk 
companies. 

This section closes with general comments on milk produc- 
tion and the importance of producing more milk and the value 
to the Commonwealth of the dairy industry. 

Section D. 

In this section the influence of heat upon milk is discussed. 
The process of commercial pasteurization as carried out in this 
State is without apparent influence upon the chemical composi- 
tion of milk. Experiments made in the commercial pasteurizing 
plants show that the process as applied is very efficient in 
lowering the bacterial content, but owing to possible reinfec- 
tion the health authorities should control the operation of these 
plants. 

PART IV. 

Section A. 

In this section is given a summary of the activities of the 
various bodies engaged in the official supervision of Massachu- 
setts milk, and a digest of the laws under which they work. 
This work is carried on by local boards of health, the State 
Department of Health, the Dairy Bureau of the State Board 
of Agriculture, the State Department of Animal Industry, and 
the United States Department of Agriculture. Local boards 



18 



of health are given authority to grant licenses, inspect dairies, 
take samples for analysis, and to make and enforce rules and 
regulations. In general they have unlimited powers to ade- 
quately supervise and control the milk supply of their respec- 
tive cities or towns. The State Department of Health and the 
Dairy Bureau have power to collect samples and to enforce the 
laws relative to the adulteration of milk. The State Depart- 
ment of Animal Industry exercises a certain amount of control 
over the health of cattle by an annual inspection made by the 
local inspector of animals. 

Section B. 

A special study has been made of the operation of local milk 
inspection from which it has been ascertained that about 
20 per cent, of the total population received no protection 
relative to milk from their local boards of health. The balance 
received some protection, but only 43 per cent, are adequately 
protected. If Boston is excluded from the list, 25 per cent, of 
the balance of the population receive no protection, and only 
28 per cent, are adequately protected from possible dangers 
arising from the milk supply. 

Section C. 

In this section the present system of dairy inspection is dis- 
cussed in relation to its sanitary value. Although in many 
instances too much importance has been attached to the condi- 
tion of the dairy and too little to the condition of the milk, 
the dairy inspection as carried out in the past has resulted in 
an improvement in our milk supply. 

PART V. 
Section A. 
It is not possible to summarize this section any further. 

Section B. 

A number of the human communicable diseases are trans- 
mitted through milk. Those of the most importance in Massa- 



19 



chusetts are tuberculosis, diphtheria, scarlet fever, septic sore 
throat and typhoid fever. 

In tuberculosis the milk may be infected by the cow pro- 
ducing it or by the human beings who handle it. 

In the other four diseases mentioned, except possibly in the 
case of scarlet fever, the infection does not originate in the 
cow; the source is in the human handlers. 

The amount of communicable disease transmission through 
cow's milk has been overestimated, but such transmission does 
occur in a degree of frequency which demands public protection. 

The infection of milk with human disease germs may occur 
at any time between its t secretion in the cow and its con- 
sumption. 

In addition to infection with human disease germs milk may 
be otherwise polluted, or may decay to a degree that renders it 
an unsafe food for human beings. 

To insure its safety as a human food two procedures of 
control are necessary. 

First. — By inspection of cattle, methods of production and 
transportation, secure a supply that is pure, clean and fresh. 

Second. — By the application of heat destroy all disease 
germs that may be in it, whether they come from animal or 
human sources. 

There are two methods of disinfection by heat in common 
use: (a) complete sterilization by boiling; (b) partial steriliza- 
tion — "pasteurization" — by heating the milk to between 
140° and 150° F. for from twenty to thirty minutes. 

Both of these methods are effective. 

The partial sterilization — "pasteurization" — seems to have 
fewer objectionable features, and is already established in this 
country as an accepted, successful process. 

To obtain the most perfect results, market milk, intended for 
human consumption as milk, should be pasteurized under the 
control of the health authorities. 

Section C. 

The infant mortality rate is still higher than it should be, — 
higher than investigators feel is inevitable. A still undeter- 
mined part of this excess is due to the quality of infant's food 



20 

and the method of its administration. Breast milk is the 
natural food for the infant. When this maternal function fails 
a substitute food is required. Modified cow's milk is the com- 
mon substitute, although it has inherent qualities that make it 
an imperfect food for infants. The supply for our cities must 
be brought from a distance. It may become polluted at any 
time between its secretion in the cow's udder and its digestion 
in the stomach of the infant. To make it reasonably safe it 
should be controlled by inspection and pasteurization up to 
the point of delivery at the home, and controlled after delivery 
by the education of the mother in hygienic methods. 

Section D. 

The exceptional place of milk as the indispensable food for 
infants and invalids is emphasized. The fact that milk is a 
unique food in the sense of being so complete in itself that it 
can sustain life alone for indefinite periods is emphasized; also 
that it is in food value one of the cheapest of foods. Under 
our present conditions there is a great economic waste of a 
part of the milk that has in itself a high nutritious value, — 
that is to say, the skimmed milk. 

PART VI. 
Section A. 

In this section the subject of grading is discussed, both from 
the bacteriological standpoint and from the standpoints of per- 
centage composition and of food values. The average milk 
sold in Massachusetts, although considerably above the stand- 
ard, is nevertheless steadily becoming more inferior in fat, the 
average of which in 1909 was 4.10 per cent., and in 1915 had 
been reduced to 3.82 per cent. The New York system of 
bacteriological control and its application is discussed. The 
commercial pasteurization of milk should be under official con- 
trol, which is not the case at present in Massachusetts, and if 
this were done the pasteurization of dirty milk, or of milk high 
in bacteria, could be prohibited. A premium should be paid 
for milk low in bacteria as well as for milk high in fat. 



21 



Section B. 

A special article is inserted in this section showing the rela- 
tion between the solids and fat in known purity and commer- 
cial milk. It is evident from a study of the charts introduced 
that commercial milk is somewhat deficient in fat. The intro- 
duction of a grading system by which milk may be sold on its 
fat percentage would stop this form of adulteration, which, 
while too slight to be proven in a court of law, yet is sufficient 
to be apparent when the averages are compared with data 
obtained from milk of known purity. 

PART VII: 

In this part the experiences of other localities is discussed. 
Section A is a special report on the New York City grading 
system from investigations made in the city of New York. 
Sections B and C are special reports on the efficiency of the 
system in the producing area. Section D is a special article 
upon this system by Lucius P. Brown, Chief of the Food Divi- 
sion, New York City Department of Health. This system has 
been studied to the best of our ability, visits being made to 
the New York City Health Department, the New York State 
Department of Health, several New York milk dealers, one 
commercial chemical laboratory in New York City, to the 
producing territory and to one country pasteurizing station in 
Connecticut. Every definite complaint relative to the ineffi- 
ciency of this system brought to our attention has been care- 
fully investigated, and in all cases these complaints have been 
found to be without foundation. The system is substantially 
as follows: — 

All milk except of a quality resembling certified milk must 
be pasteurized. If the bacteria content is high before pasteur- 
ization it must be labeled "Grade C, For Cooking Purposes 
Only." There are two other grades of pasteurized milk, 
"Grade A Pasteurized" and "Grade B Pasteurized." The 
Grade A milk is obtained from better stables, and has a lower 
bacteria content before pasteurization than Grade B milk. 
Section E gives a report of information regarding the experience 



22 

of other localities gathered at the Convention of Milk and 
Dairy Inspectors in Washington, D. C, from conversation 
with the milk inspectors of various cities and towns of the 
United States. This report cannot be further summarized. 

In Section F is given an abstract of the laws and regulations 
relative to milk in force in various States and municipalities in 
the United States. This report is of such nature that it cannot 
be further abstracted. 

CONCLUSIONS. 

Cow's milk is an invaluable article of diet. 

In the interest of the public health its use as a food should 
be maintained and extended. 

Healthy animals and proper methods are more important 
than equipment in the production of clean, wholesome milk. 

Epidemics of disease have not infrequently been caused by 
raw milk, but the amount of communicable disease so trans- 
mitted is much less than has been often asserted. 

Pasteurization. 

Pasteurization or sterilization is the only practical method 
for insuring the safety of commercial milk. 

No epidemic has ever been traced with certainty to pas- 
teurized milk. 

The present uncontrolled method of pasteurization does not 
furnish a satisfactory safeguard to the public. 

To make certain of the adequacy of the processes of steriliza- 
tion or pasteurization, the responsibility therefor should rest 
upon public health officials. 

Employees in commercial pasteurizing plants should be sub- 
jected to routine physical examination. 

Pasteurization should not be allowed to be used to conceal 
an inferior quality of milk. 

Milk in the Possession of the Consumer. 

Fresh milk has a greater food value than other milk. 

Milk, while in the possession of the consumer, should be no 
less scrupulously cared for than while in the hand of the producer 
or dealer. 



23 

(a) It should be immediately placed in a cool place and kept 
there, duly protected, until used. 

(b) All milk bottles received by the consumer should be 
washed with soap and hot water as soon as the milk has been 
removed, and should be kept clean until returned to the dealer. 

(c) Milk bottles should never be used for anything but milk, 
as is provided for by statute. 

Tuberculosis. 

In addition to epidemic diseases, the evidence is now con- 
clusive that a very considerable proportion of tuberculosis in 
children is due to infection by the bovine type of tubercle 
bacilli taken into the body by drinking raw milk. 

Bovine tuberculosis is prevalent to a dangerous degree in 
ordinary dairy herds. 

Dairymen should attempt to eradicate tuberculosis from 
their herds, not only in the interest of public health, but also 
to improve the quality of their young stock. 

Adequate pasteurization as effectively destroys tubercle 
bacilli as it does the germs of epidemic diseases. 

Milk for Infant Feeding. 

Cow's milk is decidedly inferior to mother's milk as a food 
for infants, but clean cow's milk is the best as well as the most 
common substitute for mother's milk. ( 

Some part of our excessively high infant mortality rate is 
probably due to unwholesome qualities of the cow's milk 
furnished to infants. It is generally admitted, however, at 
present, by children's specialists and sanitarians, that the use 
of cow's milk regardless of quality furnishes only one among 
many factors in the total causes of infant mortality. 

There appear to be some grounds for concluding that in some 
cities of this Commonwealth the inadequacy of the total sup- 
ply of cow's milk for infants and young children is a more 
serious public health problem than any existing deficiencies in 
quality. 



24 



Existing Inspection. 

The present laws for the supervision of milk production and 
distribution in Massachusetts give ample authority to the 
cities and towns to protect their milk supplies in as stringent 
and thorough a fashion as they may see fit. 

These laws make it mandatory upon cities and towns to 
carry out thorough dairy inspection in all dairies supplying 
milk for their consumption. 

The present system of sanitary supervision of milk by local 
authorities is in the aggregate costing the people of the Com- 
monwealth fully as much if not more than a complete, well- 
balanced, uniform system of control. 

As these laws are carried out the practical results are (1) 
that the inhabitants of many cities and towns receive no pro- 
tection whatsoever, and the inhabitants of many other cities 
and towns receive protection at the expense of the taxpayers 
in neighboring cities; (2) responsibility is divided, official 
friction between cities and towns is incurred; (3) the literal 
carrying out of the laws would result in an inconceivable mass 
of overlapping inspections; (4) the producer not having a fixed 
standard, owing to the changing and contradictory orders of 
local milk inspectors, is confused and discouraged. 

State Control. 

There is no law at present providing for State control of the 
milk, supply of this Commonwealth relative to the public 
health. 

The systematic dairy inspections instituted in this State by 
the State Board of Health, and subsequently carried on by 
local authorities, have been productive of improved dairy condi- 
tions and an improved milk supply, many producers having 
taken advantage of the opportunities of obtaining valuable 
information from the inspectors. 

The clean milk contests of the State Board of Agriculture 
have been productive of much good among those producers 
who distribute milk of their own production direct to the 
consumer. 



25 

Milk production should be so supervised as to result in a 
maximum of cleanliness and safety with a minimum of inter- 
ference with the milk industry. 

Sale of Milk. Prices. 

At the present prices, or even at considerably higher prices 
than those prevailing at present, milk is one of the most 
economical of foods. 

There are no reasonable grounds for believing that the retail 
price of milk can be lowered. 

Milk should be bought and sold on its merits as determined 
by its chemical and bacteriological condition rather than by 
volume only. This should include higher price for higher fat 
content and higher price for low bacterial content. 

Massachusetts Dairies. 

Massachusetts dairymen must produce milk of a superior 
quality if they are to hold the confidence and patronage of the 
consumers of the Commonwealth. 

As far as statistics are available it would appear that Massa- 
chusetts dairymen produce more milk per cow than dairymen 
of neighboring States and countries, and produce it under gen- 
erally better conditions as to cleanliness. 

Nevertheless, milk production in Massachusetts has rapidly 
decreased since 1890. 

To supply the steadily increasing population of the State 
with milk and cream, the large dealers of Boston and other 
cities have been going to points in other States (principally 
Maine, Vermont and New Hampshire) and the province of 
Quebec to secure adequate supply. 

The great distance of some of these points, together with 
careless handling and slow transportation, tends to place a 
large amount of milk on the Massachusetts market which is 
less desirable than milk produced near by. 

Sufficient milk to supply Massachusetts people could be pro- 
duced within the borders of the State if the thousands of acres 
of naturally good dairy lands now lying idle were stocked with 
milch cattle. 



26 

The principal reason for the decline in dairying in this State 
is the low price paid to producers. 

Other causes are the increase in the cost of cows, grain, 
building materials, labor and the improved methods demanded 
by State and municipal authorities, as well as constant legis- 
lative agitation for several years. 

Milk can be bought at lower prices at out-of-State points 
than Massachusetts farmers can produce it with profit. 

Milk transportation rates are lower in proportion for long 
haul than for short haul. 

Massachusetts dairymen have been in general subjected to 
a more rigid enforcement of dairy rules and regulations than 
out-of-State producers of milk. 

Massachusetts dairymen furnishing milk for near-by con- 
sumption must compete with an inferior grade of milk pro- 
duced out of State, which has been freed from disease germs 
by pasteurization, and has been rendered macroscopically 
acceptable to the consumer by clarifying processes to remove 
filth originally introduced by slovenly dairy methods. 

Owing to the fact that in Massachusetts there are scarcely 
any country-receiving milk stations, milk produced in Massa- 
chusetts must be marketed more quickly than milk produced 
out of State which has been clarified and pasteurized before 
being shipped. 

It would be an advantageous practice if Massachusetts dairy- 
men would label State-raised milk as Massachusetts Milk, 
particularly if a State authority could, after examination, 
permit its sale as a distinct grade of milk. 



27 



PART I. HISTORICAL. 



A. DEVELOPMENT OF PRESENT MILK CONTROVERSY. 

It would be hard to say when the milk business became the 
subject of discussion between various interests, but probably at 
a time more than twenty years ago it became a subject of bitter 
controversy between producers and the so-called contractors; 
dairymen claiming that they were not paid a fair price for milk, 
and that the. surplus system and some other features made it 
an absolutely losing proposition to produce milk to be sold to 
the large dealers. Complaints were numerous of the methods 
employed in transportation. The many ways in which the 
farmers had been, or claimed to have been, defrauded, either 
by a system of discounted price for surplus milk or by the fail- 
ure of dealers to pay for the milk, added to the confusion. 
Efforts were made by different organizations, either of Massa- 
chusetts or New England dairymen, to eliminate some of the 
troubles, but it seems that they were not successful, as we hear 
the same complaints to-day about the price of milk and of 
transportation methods. So bitter were the controversies be- 
tween the producers and the large dealers that many of the 
dairymen either reduced the amount of milk production on 
their places or went out of business altogether. 

On the other hand, the contractors have claimed that the 
price they paid was all that was possible, when the cost of 
handling and the price received by them from the consumer 
were taken into consideration, and they have always claimed 
that the margin of profit was small. Many times contractors 
have claimed that no satisfactory adjustment of prices could 
ever be made until the consumer was willing to pay more for 
milk. 

The question of transportation is still under discussion. 
Claims are made by different dairymen- that under the present 
system of handling milk on the railroads they cannot market 
their milk to the best advantage. The railroad companies, 
principally the Boston & Maine, have claimed that there was 



28 

no profit, and many times a loss, in the transportation of milk, 
and have recently asked the Public Service Commission of 
Massachusetts to consent to an increase in transportation 
rates. 

In recent years, beginning with 1906, when the first system- 
atic dairy inspection was made by the State Board of Health, 
there have been many discussions as to the right and justice 
of the dairy inspection as conducted by the State or local 
boards of health. Inspection methods have received a great 
deal of criticism, and complaints made that the multiplicity 
of inspections has tended to make the production of milk a 
very unsatisfactory business. The positions taken by certain 
health authorities and prominent social workers that milk was 
the cause of much disease and many deaths among infants of 
our large cities, and many published reports of cases of dis- 
eases and deaths caused by milk-borne epidemics, have been 
assailed by many dairymen as unjust and tending to harm the 
business to such a degree that the business is becoming less 
profitable on this account as well as on account of the activi- 
ties of the inspectors. The result of these controversies be- 
tween producers, contractors, health authorities and organiza- 
tions has been the introduction of legislative bills that have 
generally served to keep up the constant agitation. 

The following have taken more or less active part in the dis- 
cussion of milk conditions in Massachusetts, but have seemingly 
never arrived at any definite conclusion or settlement of the 
situation: The Boston Chamber of Commerce, the Grange, 
State Board of Agriculture, the Department of Animal Indus- 
try, Milk Consumers' League, labor organizations, Milk and 
Baby Hygiene Associations, the contractors, medical societies 
and others. 

In the year 1912 efforts were made to bring together the 
State Board of Health, the State Board of Agriculture, and the 
executive committee of the Massachusetts State Grange and 
various dairymen, so that there might be, if possible, a settle- 
ment of some of the difficulties in the milk business. 

The local milk inspectors have generally appeared at legisla- 
tive hearings, and have taken an active part in opposing legis- 
lation tending to centralize the authority of milk inspection; 



29 

but up to the present time there has never been any legislation 
that would satisfy all of the parties concerned, and the future 
must decide how this vexatious problem can be fairly adjusted. 

B. EARLIER INVESTIGATIONS. 

There have been three previous investigations of the milk 
situation in Massachusetts carried out during the past six 
years. They are — 

(a) The investigation into the cost of production, transporta- 
tion and marketing of milk within the Commonwealth by a 
joint special committee of the General Court of 1910. 

(b) The report of the special commission, consisting of the 
members of the Dairy Bureau, of the State Board of Agricul- 
ture and two additional members appointed by the Governor, 
authorized by a resolve of the General Court of 1910. 

(c) The report of the special committee on milk of the Bos- 
ton Chamber of Commerce, issued in July, 1915. 

Your Board has made a careful and intensive study of the 
subject-matter of these three reports, and as far as they have 
been .available have examined the original data upon which 
these reports are based. 

In the case of the first report, through the courteous co- 
operation of the Hon. Charles M. Gardner, a member of this 
committee, your Board has had access to and has thoroughly 
studied for several months past the verbatim testimony pre- 
sented at the numerous hearings of this committee. 

In the case of the last report, through the courtesy of the 
officials of the Boston Chamber of Commerce, especially Mr. 
John C. Orcutt, assistant secretary of the Chamber of Com- 
merce, in charge of this investigation, your Board has had 
access to practically all the facts upon which this report is 
based. 

In the case of the second investigation in the introduction 
to that report the following sentences occur: "The first step 
was to secure and place on file for reference as complete data 
as were obtainable from every State which has a system of milk 
inspection. This resulted in the collection of a vast amount 
of information regarding milk inspection and handling. All 
these data have been studied, compiled and tabulated, and put 



30 

in concise form for future reference." Persistent and diligent 
inquiry addressed to all the individual members of this Com- 
mission has failed up to the present to unearth any of these data 
referred to for our enlightenment. We may add parenthetically 
that this striking example of how easily valuable data, com- 
piled for the express purpose of having them accessible for future 
reference, become completely lost to sight in a few years' time 
has been the cause, to no small degree, of your Board adopting 
a radically different policy in reference to the data that we have 
compiled. We feel that we might also fairly lay claim to having 
accumulated at least a considerable "amount of information," 
but we have included practically all of it, that in our opinion 
has any direct value to the question under investigation, in 
either the body of our report or among the appendices. 

(a) Abstract of the Report of the Special Joint Milk Investi- 
gating Committee of the General Court of 1910. 

This committee considered themselves limited, by the terms 
of the order creating the committee, in their scope of inquiry 
to "an investigation of the methods and costs of said produc- 
tion, transportation and marketing." 

They concluded and reported essentially as follows: — 

1. That milk on the average could not be produced in 1910 
in Massachusetts at an actual cost to the producer of less than 
4 cents per quart. 

2. That the "control" of producers by the "contractors" 
of the metropolitan district of Boston "tends to create and 
maintain a monopoly in the sale of milk, and to restrain com- 
petition in the supply and price of milk." 

3. That "the cost and methods of transportation are of great 
importance to the consumer as affecting not only the cost of 
milk to him, but also its freshness." They go on to condemn 
the "leased car" system on this basis, and specifically recom- 
mend repeal of certain sections of the (then) transportation 
statutes, and the substitution therefor of the "flat-rate system." 

4. That there was no definite proof of any collusion between 
the different "contractors" as to price and territory, but the 
committee, on the contrary, express themselves satisfied that 
the contractors are truly competing with each other, and also 



31 

that the contractors are making a fair profit on their invest- 
ment. 

5. That regular and adequate sanitary inspection of market 
milk is necessary in the interests of the public health. 

6. That this (i.e., work of milk inspection) cannot be properly 
and economically done by the health officers of the several 
cities and towns. It should be done by some central authority. 
To do this "requires an examination of existing laws, the en- 
actment of new, and the repeal or modification of existing laws 
which would consume much time." They then recommend 
that the Dairy Bureau be charged with the duty of formulating 
a general bill to cover these points. 

This report was signed by five of the seven members of the 
committee, one member concurring in all except the recommen- 
dation for further reference to the Dairy Bureau, urging the 
formulation and passage of immediate corrective legislation; 
one other member concurring in the minority opinion, and also 
filing an opinion that the joint special committee itself should 
have recommended specific legislation to "remedy the abuses 
and the iniquities of the present transportation system." 

(b) Report of the Committee on Inspection of Milk of 1910. 

Following the recommendations of the special joint committee 
on milk of the General Court, a resolve was passed directing 
the Dairy Bureau of the State Board of Agriculture, "together 
with two additional persons to be appointed by the governor," 
to prepare a bill for the inspection of market milk in all its 
stages from cow to consumer, to make such amendments as 
would eliminate duplication of inspection or conflicting pro- 
visions in existing laws, and to thoroughly cover the sanitary 
aspects of the milk question. 

The Commission held hearings, traveled to other points in 
the United States, and did more or less inspecting of dairies 
and milk plants, as well as examining the laboratory equipment 
for milk examination of various cities, and conferring with 
local health authorities. 

They found existing duplication of laws and of law enforce- 
ment, but rather strangely make no reference in their report to 
the large number of cities and towns in which no real milk 



32 

inspection or supervision of any kind existed (for your Board's 
investigation reveals the fact that in 1910 there was even less 
supervision of milk by local authorities than at present). They 
concluded that existing laws operated to the disadvantage of 
Massachusetts producers as competitors with out-of-State pro- 
ducers. 

They recommended a State-administered uniform system of 
milk inspection enforced by a special State Milk Board, which 
body should have broad legislative and executive powers. 

They point out that both the sanitary and economic as- 
pects of milk production demand reasonable consideration, and 
urge that no system of State inspection of milk be put into 
effect unless funds are available to adequately enforce it. 

A minority report signed by the two appointed members 
agrees in the general scheme proposed, but dissents from the 
recommendation for a Special Milk Board, recommending in 
the place of it that "the milk act and its regulations should 
be administered by the State Board of Health, in a milk di- 
vision established for this purpose." 

The direct result of this investigation and report has been 
an annually recurring crop of proposed acts to settle the milk 
questions of the Commonwealth, none of which have ever be- 
come enacted. (Their provisions are discussed in the following 
section.) 

(c) The Boston Chamber of Commerce Report of 1915. 

Recently the Boston Chamber of Commerce has made an 
extended report upon an investigation into the milk situation 
of New England. This report naturally and properly confines 
itself largely to the "business aspects of the milk problem." 
It also takes up the entire question from a New England rather 
than from a Massachusetts standpoint. 

The salient features of this report are that the milk industry 
of Massachusetts is steadily shrinking, but that under certain 
conditions it might be revived. This result in the opinion of 
this committee might be brought about by establishing uniform 
systems of grading and labeling throughout New England 
(method by which same is to be accomplished not specified); 
by development of co-operative receiving stations by the pro- 
ducers; by better bookkeeping by farmers; by reform of trans- 



33 

portation methods; by improvements in distribution systems; 
and by advertising more widely the comparative food value of 
cow's milk. 

Your Board has found in many quarters of New England, 
especially among producers, a deep-seated skepticism as to the 
impartiality and real reason for this Boston Chamber of Com- 
merce investigation. This has usually taken the form of a 
direct charge that the entire investigation was undertaken and 
carried through at the instigation of transportation interests. 
If there be any truth in this very widespread impression, a 
careful study of the report itself; does not reveal any definite 
internal evidence to support it. 

C. SUMMARY OF PROPOSED LAWS RELATING TO MILK. 

The following is a list of laws which have been proposed for 
the control of the production, handling and sale of milk in the 
State of Massachusetts during the past five years. 

Proposed, 1910. 

1. To permit Boston to control its own milk situation. 

2. Prohibiting mixing anything with the whole, raw milk. 

3. Providing for milk board of three from State Board of Health, three 

from Dairy Bureau, to make regulations to be enforced by local 
board of health. t 

4. Providing State Board of Health to make regulations to be enforced 

by local board of health. 

5. Providing Dairy Bureau to draft bill which would wipe out con- 

flicting and duplicating inspections. 

6. Providing commission to investigate milk from cow to human stomach. 

7. Regulating railroad rates for transportation. 

8. Repealing present laws (Acts of 1906, chapter 463, Part II., sections 

202 to 204) which attempt to regulate railroad rates and methods. 

Proposed, 1911. 

In 1911 five bills were proposed for regulation, all mainly 
identical, but differing chiefly as to who should make and who 
administer the regulations. 

1. State Board of Health to make and administer rules and regulations. 

(House 1332.) 

2. Unpaid board, three from Board of Health, three from Board of Agri- 

culture; to make and administer. (House 1476.) 



34 

3. Paid board, two from Board of Health, two from Board of Agri- 

culture, and one chosen by .these, to make regulations. Adminis- 
tration in local boards of health. (House 1943.) 

4. No pay mentioned. Appointed by the Governor, — two medical 

men, two practical producers, one sanitarian; to make regulations. 
Administration in Milk Division, State Board of Health. (House 
2002.) 

5. Paid board, appointed by the Governor, five members, two medical 

and two producers; to make and administer regulations. (House 
2054.) 

The following bills were also proposed: — 

1. Requiring license for all dealers without reference to amount sold 

or to whom sold. (House 361.) 

2. Authorizing establishment of milk-distributing stations. (House 496.) 
.3. Labeling milk. (House 1319.) 

4. Providing standard bacteria count not over 500,000. (House 1130.) 

5. Any city or town to issue permits. (House 350.) 

Passed, but vetoed, 1911. 

House 2082, passed and vetoed by Governor Foss, was identical with 
House 2002, except as follows : — 

House 2002 prohibited selling without a permit by dealers except "those 
selling to others than consumers." This bill prohibited selling without 
a permit by dealers except "those selling solely to others than con- 
sumers." (Section 4.) 

House 2002 stated: " This bill not to be construed to make legal what 
is now prohibited nor to affect present local regulations." (Section 20.) 

House 2082 added, "provided said municipal regulations do not conflict 
with this act nor with regulations which may be made under it." 

Proposed, 1912. 

1. No pay mentioned. Five members appointed by Governor with 

advice of Council, — two medical, two producers, 1 sanitarian; 
to make regulations. Administration, State Board of Health. 
(House 1570, Ellis.) 

2. Paid board, six members; three from State Board of Health, three 

from State Board of Agriculture; to make regulations. Administra- 
tion by local boards of health.' (House 1571, Meaney.) 

3. Giving full power to State Board of Health to make and administer 

regulations on milk question. (House 1049, Withington.) 

4. State Board of Health to make regulations subject to approval by 

Governor and Council, and requiring publishing in advance of 
approval. (House 1568, Fowler.) 



35 



Proposed, 1913. 

1. Authorizing local board of health to issue permits or forbid sale. 

(House 612, City of Boston.) 

2. Stating many prohibitory conditions, including maximum bacteria 

count of 200,000 to be administered by State Board of Health. 
(House 1569, Putnam.) 
5. Almost identical with House 1568, 1912, except instead of State Board 
of Health making and administering rules and regulations, a special 
milk board of five members, appointed by the Governor and Council, 
— two medical, two producers, one sanitarian, — is provided; regu- 
lations to be published and then approved by Governor and Council, 
then to be administered by State Board of Health. (House 393, 
Bradley.) 

Proposed, 1914. 

1. Relative to inspection of dairies and cows and of barns and other 

enclosures where cows are kept for the production of milk. Except 
in case of contagious disease now under jurisdiction of State Board 
of Health, no other inspection shall be made than that by the Com- 
missioner of Animal Industry, such inspection to be made under 
such regulations as agreed upon by State Board of Health and said 
Commissioner. (Senate 234, Moore.) 

2. Relative to inspection by boards of health of milk and other articles 
' of food with right to seize unwholesome or unfit milk or food. 

(House 877.) 

3. Relative to licensing of persons, partnerships, corporations, except 

the producer selling to others than consumers or not to exceed five 
quarts per day to consumers, in cities or towns where a milk in- 
spector is appointed. (House 588, McGrath.) 

4. Providing for State milk regulation board to make regulations for 

production, transportation, keeping and sale of milk; five members 
appointed by Governor with- advice and consent of Council, two 
learned in the science of medicine or bacteriology, two practical 
producers and one sanitarian. Rules and regulations to be approved 
by Governor and Council and administered by State Board of 
Health or other municipal boards of health. Appropriation $50,000. 
(House 775, Bigelow.) 

5. Safeguard the public health from dangers of milk injurious to public 

health. Boards of health of any city or town authorized to exclude 
milk or cream deemed to be injurious to health. Prohibiting the 
bringing into the State for sale in any city or town such milk or 
cream as may have been condemned. Penalty $25 to $100. (House 
780.) 

6. Terms "milk" and "pure milk" to be defined. The terms "milk" 

and "pure milk" as used in section 55 of chapter 56 of the Revised 
Laws to apply to cream, buttermilk or any fluid or semi-fluid product 



36 

of milk except evaporated, concentrated or condensed milk when 
not diluted with water, which is to be employed as milk, cream or 
buttermilk. In the manufacture of evaporated, concentrated or 
condensed milk the use of cane sugar is permitted. (House 781.) 

7. For further regulations of prosecutions in milk cases. A dealer of 

milk not to be liable to prosecution unless the sample of milk which 
it is charged he has sold, exchanged, delivered or had in his posses- 
sion with intent to sell, exchange or deliver was taken upon his 
premises or while in his possession by the inspector of milk or by the 
agent of the Dairy Bureau or of the State Board of Health, and a 
sealed portion thereof was given him at the time of taking. (House 

934, Connor.) 

8. Regulation of sending of results of analysis of milk by inspectors. 

Amending section 63 of chapter 56 of the Revised Laws so that such 
inspectors shall send to persons responsible for the condition of 
sample of milk the results of the analysis within three days. (House 

935, Connor.) 

9. Massachusetts Milk Consumers' Association for protecting the public 

health and the promotion of the milk industry of the Common- 
wealth. State regulation, milk board; five men appointed by the 
Governor with the advice and consent of the Council, two learned 
- in medicine or bacteriology, two men of practical experience in the 
production of milk and one sanitarian. Regulations to be approved 
by Governor and Council and administered by State Board of 
Health and municipal boards of health under supervision of State 
Board of Health. Permits from State Board of Health to sell milk. 
Creation of milk division of State Board of Health, with chief of 
division and milk inspectors not to exceed twenty in number 
and such other employees as necessary. Appropriation $50,000. 
(House 936.) 

10. To prohibit the sale of milk and milk products produced under in- 

sanitary conditions. Fine of not more than $300 or imprisonment 
for sixty days, or by both. Supreme Court to have jurisdiction in 
equity upon appeal of State Board of Health or any local board of 
health to enjoin sale of such milk or milk products. (House 937, 
Sullivan.) 

11. To exclude out-of-State milk not produced or handled under sanitary 

conditions. The State Board of Health is authorized to spend for 
salaries and expenses for necessary inspection of dairies, creameries, 
stores and contractors' plants, railroad cars used for the transpor- 
tation of milk, and other conveyances and places outside the State 
in which milk, cream or their products are stored when they are 
intended for sale within this State. Appropriation $35,000. Penalty 
$300 or ninety days' imprisonment, or both. 
Milk to be labeled or marked by name of State in which it was produced, 
and also what artificial treatment, if any, has been employed, as 



37 

"Massachusetts Milk," "Maine Milk," "New York Milk," etc.; 
"pasteurized," "natural," "modified" or "compound milk." Milk 
pasteurized two or more times shall be so marked. Penalty clause 
not filled in. (House 1409, John J. Lydon.) 

12. Amendment to law relative to inspection and sale of milk. Sample 

of equal size, sealed and delivered to the person having milk sampled 
at the same time when sample is taken for analysis. Results of 
analysis to be sent to party within five days. Twenty-day clause 
for producers. Cities of 50,000 population or over shall cause all 
milk or cream sold therein to be pasteurized at 145 degrees F. for 
thirty minutes. All milk inspectors, as provided by law, shall pub- 
lish monthly records of analyses and names of persons from whom 
samples were taken. (House 1408, Murray.) 

13. Producers of milk shall be reimbursed for damages suffered from 

non-sale of milk during epidemics as a result of orders of boards of 
health. (House 1520, Kimball.) 

14. Every city and every town of over 6,000 population shall establish 

public milk stations in charge of milk inspectors or other persons 
designated by local boards of health. Distribution shall be made 
for the sole purpose of benefiting persons whose personal or family 
conditions make it imperative that they be entitled to the benefit 
thereof, the price of the milk to be subject to the control of the 
local board of health, with the right of appeal to city council or 
board of selectmen. Milk to be inspected once a week at least to 
v avoid danger. Business shall be conducted so that no financial loss 

to distributors shall take place or to establish no offensive competi- 
tion with local dealers. (House 2104, Arkwell.) 

15. To authorize cities and towns to compensate certain owners of milk 

at prevailing wholesale rates when owners are prevented from selling 
by orders of boards of health because of presence of contagious or 
communicable disease. No compensation if existence of disease is 
due to negligence or fault of owner. (House 2158, Putnam.) 

16. Relative to inspection by boards of health of milk and other articles 

of food. Right to seize unwholesome of unfit milk or food. (House 
2156.) 

D. SUMMARY OF PRESENT MILK LAWS. 

Boards of health of cities shall, and boards of health of towns 
may, appoint milk inspectors, compensation determined by the 
appointing boards. (Acts of 1909, chapter 405, amended by 
Acts of 1910, chapter 114.) 

No person in the milk business shall be appointed an in- 
spector of milk. (Acts of 1910, chapter 457.) 

Each inspector shall be sworn and shall publish his appoint- 



38 

ment for two weeks in a newspaper. (Revised Laws, chapter 
56, section 51.) 

Inspectors shall keep an office, and record in books the name 
and place of business of all persons engaged in the sale of milk. 
The board of health may employ collectors who shall be sworn. 
The inspectors or collectors may enter premises and take sam- 
ples of milk. They shall upon request make sealed samples, 
a receipt for which must be given to the inspector. The in- 
spectors shall cause such samples to be examined, and shall 
keep a record of the analyses. If sealed sample is refused no 
evidence of the analysis can be introduced. (Revised Laws, 
chapter 56, section 52, amended by Acts of 1909, chapter 405.) 

The State Department of Health may appoint inspectors, 
analysts and chemists. Inspectors have the same authority to 
collect samples as is given to inspectors and collectors of milk. 
(Revised Laws, chapter 75, section 5, amended by Acts of 1910, 
chapter 394.) 

The State Department of Health has appropriation of $17,500, 
three-fifths of which must be spent for the enforcement of milk 
laws. (Revised Laws, chapter 75, section 6, amended by Acts 
of 1903, chapter 467; 1907, chapter 208; 1911, chapter 296.) 

The Board of Agriculture at its annual meeting appoints a 
general agent of the Dairy Bureau. The Dairy Bureau con- 
sists of three members, one of whom is, appointed annually by 
the Governor for a term of three years. The secretary of the 
Board of Agriculture is the executive officer of the Bureau. 
The Bureau inquires into the methods of butter and cheese 
making, and enforces the laws relative to the sale of all dairy 
products and their imitations. The Bureau has an appropria- 
tion of $8,000 per annum. It may co-operate, but must not 
interfere with the State Department of Health and with in- 
spectors of milk. The agents of the Bureau have the same 
authority as is given to inspectors and collectors of milk. Pen- 
alty for obstruction, first offence, $100; subsequent offences, 
$200, with fine payable to the Treasurer of the Commonwealth. 
(Revised Laws, chapter 89, sections 5, 11, 12 and 13, amended 
by Acts of 1891, chapter 412; 1892, chapter 139; 1894, chapter 
280; 1895, chapter 214; 1900, chapter 368; 1905, chapter 155; 
1907, chapter 401; and 1908, chapter 416.) 



39 

Unlawful to sell milk without a permit. Permits are issued 
by local boards of health after a satisfactory inspection of the 
milk and of the dairies and of the premises upon which the 
milk has been handled. No charge for inspection. These in- 
spections must be made by the authorized agents of the board. 
The boards may require such reasonable conditions as they see 
fit. If a permit is revoked the board of health must notify the 
State Department of Health. The latter must notify other 
boards of health in whose jurisdiction the milk is liable to be 
sold, and must notify dealers liable to purchase the milk. Un- 
lawful to sell after receiving such notice. Permits may be 
reissued by local boards of health. Penalty not more than 
$100. (Acts of 1914, chapter 744, amended by Acts of 1916, 
chapter 228.) 

Unlawful for any State or municipal inspector to charge for 
the inspection of live stock, dairy, etc. (General Acts of 1915, 
chapter 109.) 

No person shall sell milk without a license. Exception: a 
producer selling to dealers or not more than 20 quarts to con- 
sumers. The license shall be numbered and shall contain the 
name, place of business, residence, number of wagons and 
names of drivers, and shall be conclusive evidence of owner- 
ship. Name, place of business and license numbers must be 
painted on wagons, and license must be posted in stores. Pen- 
alty for operating without a license, first offence, $10 to $100; 
second offence, $50 to $300; third offence, $50 and imprison- 
ment for thirty to sixty days. Fee for license, 50 cents. Li- 
cense remains in force until the first day of June. May be 
revoked for violation of the terms of the license. If license is 
revoked licensee has an appeal to the State Department of 
Health, whose decision shall be final and conclusive. (Acts of 
1909, chapter 443.) 

Utensils used in determining fat by the Babcock or other 
centrifugal methods must be approved or calibrated by the 
Massachusetts Agricultural Experiment Station. Persons oper- 
ating these machines must have a certificate from the experi- 
ment station. Exception: persons doing such work for their own 
information, not for inspection or as a basis for payment in buy- 
ing or selling. Penalty, $15 to $50. (Acts of 1912, chapter 218.) 



40 

Milk which has been heated to a temperature greater than 
167° F. must be labeled "Heated Milk." Penalty, first offence, 
$50 to $200; second offence, $100 to $300; subsequent offences, 
$50 and imprisonment for sixty to ninety days. (Acts of 1908, 
chapter 570.) 

Sale, etc., prohibited of adulterated milk, or milk to which 
water or any foreign substance has been added, or milk from 
cows fed on the refuse of distilleries, or from sick cows, or as 
pure milk, milk from which a part of the cream has been re- 
moved, or skimmed milk containing less than 9.3 per cent, 
solids not fat. Penalty, first offence, $50 to $200; second 
offence, $100 to $300; subsequent offence, $50 and imprison- 
ment for sixty to ninety days. (Revised Laws, chapter 56, 
section 55.) 

Sale, etc., prohibited of milk below the legal standard. Pen- 
alty, first offence, not more than $50; second offence, $100 to 
$200; subsequent offences, not more than $200 or not more than 
ninety days. (Revised Laws, chapters 56 and 57, amended by 
Acts of 1910, chapter 641.) 

Producer not liable for sale of low standard milk unless low 
in both solids and fat, and unless twenty days after he has 
received notice of this fact a second sample is found by the 
same inspector to be low in solids and fat. Furthermore, sam- 
ples must be taken while in his possession or in his control by 
an inspector, and a sealed sample given. (Revised Laws, chap- 
ter 56, section 62, amended by Acts of 1910, chapter 641.) 

Standard: solids, 12.15 per cent.; fat, 3.35 per cent. (Re- 
vised Laws, chapter 56, section 56, amended by Acts of 1908, 
chapter 641.) * 

Skimmed milk may be sold if labeled with the words 
"Skimmed Milk" in letters 1 inch in length. (Revised Laws, 
chapter 56, section 58.) 

Use, etc., of counterfeit seal, or tampering with sample, 
punished by fine of $100 or imprisonment three to six months. 
(Revised Laws, chapter 56, section 60.) 

Obstruction of inspector punished by fine ef $100 to $300 or 
imprisonment thirty to sixty days. (Revised Laws, chapter 56, 
section 61.) 

The inspectors must make complaint upon receipt of evi- 
dence. (Revised Laws, chapters 56 and 64.) 



41 

Analyses of samples must be sent to the person from whom 
sample was taken. (Revised Laws, chapters 56 and 63.) 

Use of unclean containers and implements punished by fine 
of not more than $50. (Acts of 1913, chapter 761.) 

Placing substances other than milk and milk products and 
cleaning fluids in milk cans or bottles punished by not more 
than $10 for each vessel misused. Returning dirty cans to 
producers punished by fine of not more than $10 for each such 
vessel. (Acts of 1906, chapter 116.) 

Milk dealers must not use cans not their own. Penalty, $10. 
(Acts of 1906, chapter 116, amended by Acts of 1908, chapter 
435.) 

Commissioner of Animal Industry may inspect premises 
where cattle, etc., are kept. He may make and enforce regula- 
tions for the sanitary condition of the premises subject to ap- 
proval by the Governor and Council. State Department of 
Health, Dairy Bureau and boards of health must report all 
premises found to be unsanitary. Penalty for obstruction, not 
more than $50 or imprisonment not more than thirty days. 
(Acts of 1911, chapter 381.) 

Feeding garbage collected by a city or town to milch cows 
prohibited. Penalty not more than sixty days or not more 
than $100. Feeding garbage collected from a city of more than 
30,000 inhabitants to any animal except swine prohibited. Pen- 
alty, not more than thirty days or fine not more than $50. 
(Revised Laws, chapter 213, section 5.) 

Medical milk commissions may be formed. The members 
of the board of health may be ex officiis members. Members 
shall receive no compensation. The corporation may make 
agreements for the production of milk under their supervision, 
but the conditions shall not fall below those imposed for cer- 
tified milk by the American Association of Medical Milk Com- 
missions, or below the statutory standard. Penalty for sale of 
milk not conforming to the regulations, not more than $100. 
(Acts of 19U, chapter 506.) 

Boards of health of cities and of towns having 10,000 or more 
inhabitants may establish stations for the distribution of milk 
free of charge or at such charge as the board may establish. 
The boards, however, must not engage in the general milk 
business. (Acts of 1911, chapter 278.) 



42 



PART II. STATEMENTS OF VARIOUS INTERESTS. 



INTRODUCTION. 

It was the desire of your Board to obtain as many view- 
points from as many different interests concerned in the pro- 
duction and the sale of milk as possible, and therefore a num- 
ber of letters were sent to different organizations. 

A questionnaire of nine questions was sent to .certain of the 
large milk contractors; six questions requested definite informa- 
tion upon certain phases of the operation of their business, and 
three were relative to their opinion of the present milk 
situation. Letters were sent to cattle breeders' associations 
asking whether or not they would approve of selling milk upon 
its fat percentage. A letter was sent to the State Department 
of Animal Industry relative to the inspection of cattle, and 
that Department was asked to give an opinion upon the health 
of Massachusetts cattle at present as compared with that in 
former years. 

The Boston Chamber of Commerce, the State Grange, the 
Milk Consumers League, the Milk and Baby Hygiene Associa- 
tions, the Massachusetts State Board of Agriculture and the 
Health Department of the city of Boston were all requested to 
submit statements giving the viewpoints of their respective or- 
ganizations relative to the milk situation in Massachusetts. 

The answers, wherever possible, have been reported in full, 
but in a few instances it has been necessary to make com- 
pilations. 

A. MILK CONTRACTORS. 

A questionnaire was sent to milk contractors, a portion of 
which dealt with their opinions relative to the milk situation. 1 
From the answers received the following has been compiled: — 

Question 7. — Do you consider that the present competitive system 
of retail milk delivery involves an unnecessary duplication of equip- 
ment and labor? 

1 The balance of the answers are discussed in Part III., Section B. 



43 

To this question 7 answered no, 3 yes, and. 1 gave no answer, 
stating that he made no retail sales. One complete answer is 
as follows: — 

7. In large centers of population where the business is of considerable 
volume that is carried on and operated by a dealer, we think that there 
is little chance to improve upon the city milk delivery. A number of 
years ago, when the distribution of milk was in the hands of milkmen 
who ran one or two teams, there was of necessity long drives and scattered 
deliveries. One can readily see the way the business is now carried on 
by large dealers, — a customer moving from one section of the city to 
another is simply transferred to the team delivering in that section; 
but under conditions that existed as referred to above, the small milk- 
men who operated one or two teams would either have to give up the 
customer who moved to another part of the city, or lengthen out his 
drive, which, of course, is a costly thing to do. We try to load up our 
wagons and divide the territory so that we give one man a full day's 
work, and also try to arrange the deliveries so that one horse is all that 
is necessary usually to run the team. 

Question 8. — Is there a surplus or a shortage of milk at different 
seasons of the year in your milk producing territory, and if so, please 
state your opinion of the reason therefor. 

All eleven answered yes to this question. The variation 
in the amount of milk upon the market was explained by 
natural causes, unavoidable causes and faults of production. 
The cows are generally allowed to freshen in the springtime, 
and the farmers do not attempt, as a rule, to control the flow 
of milk by regulating the time of breeding. 

On the other hand, the demand for milk varies with the tem- 
perature. During the extremely hot days there is an enormous 
demand for milk without a corresponding increase in produc- 
tion. The present shortage in the hot weather is not so severe 
as formerly, owing to the fact that many farmers are beginning 
to arrange their herds so that more milk will be produced dur- 
ing the hot weather. 

One complete reply is as follows: — 

8. Generally speaking, there is marked irregularity in the production 
of milk, the largest quantity occurring in the months of May and June, 
and the smallest in the months of October and November. Both the 
excess production and the under production from the average level result 



44 

in heavy cost to the industry. In the case of surplus no use is available 
which will yield the full cost of the milk, and in the case of shortage the 
supply has to be replenished from new sources of exorbitant prices. 

Notwithstanding instruction to producers as to the need of the market 
for even production, and notwithstanding the application of a heavy 
grade in prices, the producer, in general, persists in uneven production. 
This is due, presumably, to the tradition of producing maximum amounts 
on summer pasturage, and again, to the consideration that milk on most 
farms is not the sole product, and the production of milk is not inten- 
sively carried on. 

Question 9. — Do you consider the present milk situation in Massa- 
chusetts satisfactory from the dealer's point of view? If not, would 
you kindly state in your opinion what changes could or should be made 
to place the business on a more satisfactory basis? 

To this question seven answered no, two answered yes and 
two gave no answer. The following suggestions were made : — 

Increase the license fee to $50, which will prevent incom- 
petent men from going into the milk business, and, further- 
more, prohibit by statute any person engaging in the business 
without adequate equipment. 

Milk from uninspected sources and of doubtful origin is now 
allowed to compete with Massachusetts producers. To offset 
this, uniform regulations should be made, placing the enforce- 
ment of dairy inspection in the control of the State Depart- 
ment of Health. 

Another contractor stated that multiple inspection under the 
provisions of chapter 744 of the Acts of 1914 should be stopped 
in favor of State Department of Health inspection. Another con- 
tractor suggested lessening the legislative activity, and placing 
the inspection of dairies under the control of the State Depart- 
ment of Health. One contractor suggested compulsory pas- 
teurization of milk in large cities under the supervision of the 
State Department of Health. 

Price cutting is stated to be ruinous among dealers, as is also 
the practice of selling bottled milk in stores at cost. The selling 
of milk on its quality by different grades would give the con- 
sumer a reliable basis for a differentiation of quility, and would 
standardize competition among dealers. Another contractor 
with this same idea suggested statutes permitting the sale of 
standardized milk and the sale of milk on the fat basis. 



45 

The present conditions do not encourage milk production in 
Massachusetts. Long-distance milk is cheaper and discourages 
home production. The Saunders law did not handicap dealers 
in getting milk, but probably has been of no benefit to Massa- 
chusetts producers. 

Another contractor suggested amending the laws so that 
dealers may be seen on the street corners together without 
danger of arrest. One complete reply is as follows: — 

9. Under the law of 1914 cities and towns of the State are required 
to inspect and to license dairies supplying them with milk. This results 
in a multiplication of permits, to the extent that producers supplying 
dealers covering greater Boston may have permits from twenty boards 
of health. We believe the interests of all concerned in milk, viz., the 
producer, distributor, board of health and consumer, would be more 
agreeably, effectively and economically served by centralizing the in- 
spection of dairies under the authority of the State. 

We believe that the pasteurization of milk in the large cities of the 
State should be made compulsory, and that the process should be carried 
on under conditions prescribed by the State Department of Health. 

We believe that the sanitary problem in milk has resolved itself chiefly 
into an economic problem. Knowledge as to the sanitary measures 
required for producing and handling clean and safe milk is widely dis- 
seminated. What lacks is the application of this knowledge, which is 
a business matter. The establishment of the sale of milk on a basis of 
quality through the definition of grades would afford the consumer a 
reliable basis for the differentiation of quality, would standardize compe- 
tition among dealers, and would permit compensation of producers on 
a basis of quality. The consumer could then have the grade of milk 
desired by paying the appropriate price. We accordingly urge the es- 
tablishment of grades for sale of milk in the large cities of the State. 

We urge the enactment of law prescribing the sale of cream on a basis 
of fat. 

The present requirement of law of 9.3 per cent, solids not fat in skimmed 
milk is higher than genuine milk will show. We therefore urge a change 
to 8.75 per cent. 

We recommend that the boards of health of the towns and cities in 
greater Boston standardize their regulations controlling the delivery of 
milk to homes in which an infectious disease exists. There is now con- 
siderable difference in the requirements of different localities. Generally 
speaking, the milk dealer is held responsible to the board of health for 
seeing that this is done. We believe that the householder should be 
made completely responsible, by such means as retaining bottles in the 
household until the disease is over and until bottles have been disinfected 
by the board of health or under its direction. Such a requirement would 



46 

be seen to cover the case of bottles bought through the stores for use in 
infectious households where now, according to our understanding, they 
escape supervision. The sale of milk in bottles through the stores now 
constitutes a large part of the city supply. 

B. BOSTON CHAMBER OF COMMERCE. < 

Dec. 20, 1915. 
Mr. Edward H. Williams, Room 1^1, State House, Boston, Mass. 

Dear Mr. Williams: — I have your letter of December 18, in which 
you state that you would like to have a statement from us in regard to 
the milk situation. 

You already have copies of our milk report, which gives a summary 
of the present conditions and our opinion as to what is necessary to 
remedy some of the present difficulties. I am enclosing a leaflet which 
will give you an idea of our future plans. We are just sending the third 
edition of this report to the press. The fourth edition will come out 
some time in February. It seems to us that the first thing to do is to 
get a wide distribution of the report, co-operating with the various 
agencies interested, in order that a large number of people interested in 
the dairy industry may become acquainted with present conditions and 
the suggested remedies. 

Up to date, almost every agency has been looking at the suggestion 
from their own point of view, forgetting the bearing that the other con- 
ditions had upon their particular problem. Again, many people, in 
order to accomplish certain needed reforms, are so anxious to overturn 
in a few months conditions that have been growing for a period of many 
years that they generally do not succeed. After securing a wide distribu- 
tion of the report, we hope that a plan can be laid out by a conference 
of the agencies interested, whereby the recommendations as to the par- 
ticular phases of the production, transportation, inspection and distri- 
bution of milk and cream can be carried out step by step. 

For instance, take the grading and labeling of milk. A pamphlet 
should be issued telling how grading and labeling can be really carried 
out; what is necessary to be done in order to interest the people, such 
as holding meetings of health officials, town and city authorities, dealers, 
producers, consumers, etc.; the equipment necessary for a laboratory, 
the cost of operation and cost per sample, and the cost per capita. This 
should be figured out according to the population of the various munici- 
palities, showing what it would cost cities of, say, 500,000 and over; 
100,000 to 500,000; 50,000 to 100,000; 5,000 to 50,000; and under 
5,000. These, of course, are only fictitious divisions, and it may be 
found upon further study that they would have to be in different divisions. 
This would give in detail how the grading and labeling of milk should 
be carried out, and this is what the people need. 

The same thing should be done in regard to every recommendation 



47 

as to country milk plants, railroad transportation, better methods of 
production, distribution, etc., outlining a detailed plan of just what can 
be done, providing the people wish to take some initiative. 

Undoubtedly some legislation will have to be secured in regard to 
making the local standards more or less uniform as to milk and cream 
and ice cream; the problem of the country dairy inspection; and the 
granting of authority to boards of health to issue licenses for the grading 
and labeling of milk. Undoubtedly your Board has looked into these 
matters and is more or less familiar with the situation. 

I am sure that I personally, and other members of our committee 
would be very glad to have a conference with your committee any time 
to discuss these three particular questions, or others pertaining to this 
oft-vexed and much-perplexed problem. 

Very truly yours, 

John C. Orcutt, 
Secretary, Committee on Agriculture. 

C. MILK CONSUMERS' LEAGUE. 

The Massachusetts Milk Consumers' Association dates its organization 
from 1910. It consists of over 1,800 prominent men and about 10 women, 
very evenly distributed throughout the various representative districts 
of the State. Its purpose is: "An association formed to unite consumers 
in obtaining efficient inspection and a pure milk supply." 

The organization was evolved from three sources, namely, Dr. Charles 
Harrington, former secretary of the State Board of Health, the official 
legislative investigating committees of 1910 and 1911, and the health 
committee of the Municipal League. 

For several years prior to 1911 Dr. Harrington introduced bills in the 
Legislature designed to enable the State Board of Health to enforce its 
suggestions for cleanliness in the dairies supplying Massachusetts. In 
1905 he appointed one State Dairy Inspector, and at his death was con- 
templating extending the State inspection to out-of-State dairies. 

When asked by the chairman of the health committee of the Women's 
Municipal League what they could do to help him, Dr. Harrington sug- 
gested that they assist him in securing the passage of the bill which he 
had introduced. Because of the continued failure to get Dr. Harrington's 
bill through, it was decided to form a State organization, which subse- 
quently took the name of the Massachusetts Milk Consumers' Associa- 
tion. 

On May 5, 1910, a joint committee of the Legislature was appointed 
to investigate the milk problem. This committee, after expressing the 
necessity for a central authority administrating a uniform inspection of 
the places where the milk is produced, recommended that the Dairy 
Bureau investigate the subject. Acting on this recommendation the 
Legislature authorized an investigation by the Dairy Bureau consisting 



48 

of three members, of which Charles M. Gardner is chairman, with two 
experts, Dr. Milton J. Eosenau and George H. Ellis, to complete the 
commission. 

This commission on Jan. 2, 1911, reported a bill to the Legislature 
known as the Gardner bill. The commission unanimously found that 
existing conditions were a menace to the Massachusetts milk consumers 
and an unfair burden upon the Massachusetts milk producers. 

It was at this stage that the Milk Consumers' Association became 
active. The Ellis bill is simply the Gardner bill with practically only 
one substantial change, the details of the bills being in most cases word 
for word the same.. 

Instead of having the mixed board both pass and administer regu- 
lations, as in the Gardner bill, the Ellis bill provided that while the mixed 
board should pass the regulations the administration should be in the 
hands of the State Board of Health in order to preserve unity in health 
administration. 

There were some other changes made at the suggestion of the milk 
inspectors who met at a conference called by the association for the 
purpose of getting their ideas. The changes made at their request were 
in the line of preserving local powers. Everything they asked for was 
put into the bill. 

The bill expressed the ideas of Dr. Rosenau and Mr. Ellis, the minority 
members of the commission. 

The efforts of the association have always had the support of the 
Massachusetts Medical Society and of various local medical societies 
and innumerable other State and local welfare organizations. 

The association has constantly consulted experts on the subject 
throughout the country, and has from time to time made changes in the 
bill at the suggestion of its members and others, going as far as possible 
to remove controversial phrases. 

Many efforts have been made to come to a common understanding 
with the Grange, the Grange usually being represented by Mr. Howard 
on such occasions. 

The association has never taken any arbitrary position as to the form 
of the bill, only insisting on the central principle that the State Depart- 
ment of Health should have legal power on its own initiative, in places 
where milk is produced or handled, to insist upon reasonable cleanliness. 

In years past a great many local labor unions indorsed the bill advo- 
cated by the Consumers' Association, but this year the State branch of 
the American Federation of Labor at its State convention made the fight 
for clean milk legislation its own, and authorized its legislative com- 
mittee to introduce what was afterwards known, and properly so, as the 
labor clean milk bill. It was an entirely different bill from the Ellis 
bill, but one which was heartily supported by the Massachusetts Milk 
Consumers' Association. The members of the association voted almost 
unanimously on a referendum to support the labor bill. 



49 

After receiving the favorable report of the public health committee, 
it was passed by a two-thirds vote of each house, but was vetoed by the 
Governor. 

The original Ellis bill was passed in the first year of the association's 
campaign, but was vetoed by Governor Foss. 

D. THE STATE GRANGE. 
Session of 1911, Worcester. 

In view of all the aspersions cast upon the Grange and upon the farmers 
because of the Ellis bill episode, and the misstatements of people whose 
conduct cannot be attributed to ignorance, it seems fitting to cause this 
annual session of the Massachusetts State Grange to speak clearly and 
distinctly on the subject of milk inspection and concerning the Grange 
attitude upon health matters in this State. There are exceptions to 
every class as to every rule, but as a whole the farmers of this Com- 
monwealth are as eager to sell clean, wholesome, properly handled milk 
as any consumer is to buy it; they are as truly interested in the health 
and life of little babies as are the philanthropists of any city. No one 
in this State will more quickly condemn a filthy and disease-breeding 
stable than the great mass of our farmers themselves; and in any reason- 
able and common-sense undertaking to improve the health conditions of 
the dairy industry they will lend instant and earnest co-operation. 

They do insist, however, that those who essay to prescribe the con- 
ditions of milk production must at least be able to recognize a cow stable 
when they see one, and must understand that a farmer cannot produce 
any kind of milk, not to mention clean milk, unless he can get something 
near 100 cents for each dollar that he spends to produce that milk. 

Your State master sincerely trusts that this body will in no uncertain 
tones pledge its belief in and its support for such measures, wherever 
their origin, as propose to continually improve health conditions in our 
milk supply, by the only means that will ever prove effective, so well 
expressed in the words of the Chief Executive of the Commonwealth: 
"What we need is to penalize the farmer a little less and encourage him 
a good deal more." 

Session of 1912, Springfield. 

Confirming further our previous State Grange attitude on the whole 
milk question, we may well emphasize anew our emphatic declaration 
of one year ago, — that the final answer to all phases of the milk problem 
will be found, and speedily found if sought, in the disposition to pay the 
farmer a fair price for clean, well-handled milk, based on the belief that 
milk producers of Massachusetts will make just as good milk, even up 
to the certified class, as the consumers want to pay for. This, finally, 
is the essence of the whole question, and points the way to the line of 
milk education to-day most needed. 



50 



Session of 1913, Boston. 

In all the maze of the milk situation it is exceedingly refreshing to 
find some of the milk contractors making advances to the producers for 
a graded scale of prices, paying according to the percentage of fat value 
in the milk and the degree of cleanliness it possesses. This is highly 
significant as the trend of the times, indicating what are to be the lines 
of profitable milk production for the future; especially so because this 
is exactly the attitude the State Grange has taken for three consecutive 
years, not only by action in the annual session, but by appeal before 
the Legislature, — that the farmer will produce from his cows just as 
rich milk and just as clean milk as the consumer is willing to pay for; 
and that in respect to cleanliness the farmer is already spending far more 
in equipment and in care than the consumer does pay for. Let it be 
hoped that a graded scale of milk purchasing will ultimately become 
general, with an opportunity afforded the ambitious farmer, at a price 
commensurate with the cost of cleanliness, to produce the most wholesome 
and satisfactory milk it is possible for the combination of clean, healthy 
cows and clean, honest cow owners to produce. This is the only line on 
which milk progress can ever come, and that most people are coming to 
see this fact is one of the most hopeful signs of the times for both milk 
producers and milk consumers. 

E. MILK AND BABY HYGIENE ASSOCIATIONS. 

For the purpose of acquiring information as to the work done 
by the Milk and Baby Hygiene Associatibns, a letter of inquiry 
was sent to the following associations: Society for District 
Nursing, Worcester; Instructive Nursing Association, New Bed- 
ford; the Lowell Guild, Lowell; Visiting Nurse Association, 
Great Barrington; District Nursing Association, Fall River; 
Sanitary Milk Committee, Lawrence; Infant Hygiene Associa- 
tion, Holyoke; Milk and Baby Hygiene Association, Maiden; 
Baby Clinic Day Nursery Association, Lynn; and Miss Helen 
Dalton, Fitchburg. The letter was as follows : — 

Will you kindly send me for use in this Department in its milk investi- 
gation any published reports or data you may have in regard to the work 
being done by your society? 

Any information you can give us will be of great assistance. 

Replies were received from several of these associations, but 
none of them had anything to offer in the way of the informa- 



51 

tion asked for except the Holyoke and Boston Infant Hygiene 
Associations. From the first we received their first annual re- 
port published in 1914. This report is very interesting, and 
contains the names of the members of the association, the by- 
laws, amount of money spent on the work, and is descriptive 
in a general way. The detailed statement of the Boston asso- 
ciation follows: — 

Statement op De. J. Herbert Young. 

The Milk and Baby Hygiene Association of Boston was organized in 
1909. The purpose of the association, as stated in the first annual report, 
was — 

1. To improve the milk supply. 

2. To prevent sickness and reduce mortality among infants. 

3. To increase the health and vitality of children and their mothers. 
The methods to be used were — 

1. Encouragement of breast feeding. 

2. Distribution of clean milk. 

* 3. Maintenance of a first-class milk modification laboratory. 

4. Maintenance of milk stations in the neediest districts. 

5. Instruction of high school girls, mothers and fathers in the care of 
children. 

6. Supervision of the care and feeding of babies by skilled physicians 
and nurses at. home and at the stations. 

7. Conferences, lectures, exhibits and publications for milk consumers. 

8. Co-operation with public health authorities. 

9. Researches in bacteriology, biochemistry and sociology with reference 
to infant mortality. 

The purpose of the association remains the same; our object is to 
keep well babies well. The methods used, while essentially the same, 
have been changed somewhat to meet existing circumstances. It has 
been our experience, as time goes on, that in our work as applied to the 
individual baby, milk assumes lesser and hygiene assumes greater im- 
portance. This does not mean, however, that the association does not 
continue to have an active interest in all phases of the milk question 
as applied to infants. 

The field activities of the association are carried on from 12 milk 
stations. From these stations we cared for, in 1915, 4,800 babies. Of 
these babies about 50 per cent, were entirely breast fed, 30 per cent, 
partially breast fed and 20 per cent, entirely bottle fed. 

Bids are annually requested for the milk sold at the milk stations. 
The milk at the present time is supplied by D. "Whiting & Sons. This 
milk is sold to the mothers at cost. Milk modified at the laboratory of 



52 



D. Whiting & Sons, according to three formulae recommended by the 
association, — certified milk, inspected whole milk and fat-free milk, — ■ 
is provided. The modifications are made from milk certified by the 
Medical Milk Commission of Boston. The certified milk is certified by 
the Medical Milk Commission of Boston. 

The whole milk and fat-free milk is of the grade known as inspected. 
This milk comes from dairies which show a score on the United States 
government score card between 75 and 80 points. The cows are annually 
subjected to the tuberculin test. The milk is pasteurized at a temperature 
of 145° for thirty minutes. 

During the month of December, 1915, 494 quarts of modified milk, 
57 quarts of certified milk, 5,414 quarts of inspected whole milk and 
31 quarts of fat-free milk were sold at the 12 milk stations. 

While we believe that the best food for a bottle-fed baby is the freshest, 
cleanest and purest cow's milk that it is possible to procure, we believe 
that the milk sold by our association, or any milk of equal grade, is a 
safe food for infants. 

F. CITY OF BOSTON HEALTH DEPARTMENT. 

Eugene R. Kelley, M.D., Chairman, Milk Board, State Department 
of Health, State House, Boston. 

Deae Doctor: — In reply to your communication of the 9th instant, 
requesting an expression of my opinion on the present status of the milk 
situation, I would say that this Department has always kept in mind 
the sanitary aspect of this problem, never investigating the economic 
or political sides, and forbidding the employees of the Department from 
doing so. 

Boston is expending large sums Of money to improve the milk supply 
of this city, and the so-called metropolitan district of Boston has been 
reaping the benefit of this inspection without expense to those cities and 
towns in the district. This is manifestly .unfair to Boston, but we do 
not complain, as under the present methods of inspection it cannot very 
well be avoided. 

In my opinion the inspection of the production, handling and trans- 
portation of milk is largely an interstate problem, as about 92 per cent, 
of the milk sold in Boston comes from without the State, and should 
be supervised by the Federal authorities. As the government has refused 
to assume this responsibility, owing to lack of money to carry on the 
work, the duty should devolve on some central State authority, preferably 
the State Department of Health. 

If the State Department were to take over this work it would do away 
with a great amount of duplication in inspections and issuances of permits. 
You are thoroughly conversant with the present law regarding the 
issuing of milk permits, so I will not go into that phase of the subject, 
except to say that if a central State authority had complete supervision 



53 

over these permits it would clarify the situation wonderfully. It would 
also help the producer, as he would have only one inspecting authority 
to satisfy, instead of three or four, as at present. 

Local authorities should have complete control over the inspection 
and handling of milk within the limits of their respective cities and towns. 
The law, or statute requirements as to standards, etc., places that au- 
thority in their hands at present. 

I believe in pasteurization of all milk, except certified milk, under 
proper supervision by the local authorities of the cities and towns where 

the milk is offered for sale. 

Yours very truly, 

F. X. Mahoney, 
Health Commissioner. 



G. MASSACHUSETTS STATE BOARD OF AGRICULTURE. 

Massachusetts is peculiarly located in relation to other States of the 
New England group. With only two others smaller, and surrounded by 
them all. with New York on the west, it is the natural market for the 
group, as next to Rhode Island it is the most densely populated State 
in the United States. 

Once Boston, which is now the great milk market of New England, 
produced its own milk supply. Then as the city grew, and demanded 
among other things fresh vegetables, the cows were pushed out to the 
near-by towns, and dairying went on until again the pressure for different 
kinds of agriculture was felt, and always dairying, which was considered 
a more extensive type of agriculture, depending on large pastures and 
lands to grow cheap forage, was pushed further from the central base, 
and Boston has had to draw its milk supply first from the 20-mile radius, 
then 50, then 100, and now much of the supply comes from over 200 
miles. What is true of Boston has been true in a measure of many of 
the smaller cities; but many of these latter, owing to their proximity 
to the farm lands, have done much to encourage the dairy industry 
near by, and are, therefore, supplied with a better grade of milk than is 
usually sold in the Boston market, where now a more discriminatmg 
public is demanding that its milk supply be drawn from sources near 
the consumption line, and under conditions upon which it desires to 
impose restrictions Which are bound to increase the cost of production, 
as well as that of transportation and distribution. 

Massachusetts agriculture has seen great changes in the past one 
hundred years, chiefly owing to the severe competition of States more 
favored than we are by climate, soil or transportation facilities for the 
production and distribution of some particular crop; but in spite of the 
loss of some crops and a great reduction in dairying, the State has ad- 
vanced steadily in the value of its agricultural products since 1870, as 
the following figures will show: — 



54 

1879 - ' $24,160,881 

1889, 28,072,500 

1899 42,298,274 

1909 60,000,000 

Market gardening, fruit growing and the production of special green- 
house crops have in many instances taken the place of dairying on our 
farms, and particularly so near the cities, where it has been possible to 
obtain manure from city stables to conduct these operations. 

With the very acute fertilizer situation our farmers' attention is more 
forcibly drawn to the general problem of keeping up soil fertility, and 
were this situation to continue for long, undoubtedly it would have a 
very great effect in restocking with dairy animals many of the farms of the 
State. That there is a desire on the part of many farmers to put cattle 
back on the farm is apparent, and there is a decided feeling in many 
sections that the cow is a necessity in our agriculture; that milk should 
be treated as a by-product; that we should raise more pure-bred stock 
in this State; and that all of our dairymen should raise their own stock 
and not depend upon those shipped here. 

With our great resources in undeveloped land, salt and fresh marshes 
for growing hay, upland pastures now growing up to brush, and much 
valley land still unproductive, we certainly have a chance to produce 
all the milk, cream and butter that we consume. That we shall produce 
it some time is apparent, but with present conditions as they are, with 
our best markets flooded with milk produced in more natural dairy 
sections than ours, and hauled to these markets as cheaply as ours, Massa- 
chusetts' problem is one of producing a superior article which will be 
called for in our markets in preference to any other. 

That the dairy problem is no new one to our people is apparent from 
the following, taken from the report of the secretary of the State Board 
of Agriculture for 1884: — 

The production of milk to supply our towns and cities is a branch of husbandry 
that in late years has not been satisfactory; the farmers have allowed shrewd 
contractors to control the supply and sale of milk, and have accepted prices lower 
than the cost of production. 

In a way it is to the credit of our farmers that they have gone out of 
the dairy business rather than produce an article for which they did 
not receive a profit; but the most vital question is a readjustment of 
our agriculture, and a readjustment in which the dairy cow will play a 
prominent part. Diversified agriculture is bound to become more common 
with the exception of very favorable localities, in which rotation of crops, 
together with animal husbandry, will be practiced, and a business built 
upon quality and freshness of our products will take the place of the 
now long-distance shipments which are so common in our markets. 



55 



H. MASSACHUSETTS STATE DEPARTMENT OF ANIMAL 

INDUSTRY. 

State House, Boston, Sept. 15, 1915. 

Dr. Eugene R. Kellet, Chairman of Milk Board, State Department 

of Health. 

Dear Sir: — Your letter of September 9 at hand, and in reply will 
furnish you with what information I can on the different subjects 
mentioned. 

On account of the prevalence of foot-and-mouth disease this past 
season the annual inspection of animals and premises by the local in- 
spectors of animals throughout the State was abandoned. This animal 
inspection is generally recorded during the early spring months, when 
the animals are all in the barns and can be more conveniently examined, 
and in order that disease which may have been influenced by the housing 
of the animals during the winter months may be recognized. On account 
of the danger of spreading foot-and-mouth disease by the medium of 
the local inspectors of animals going from farm to farm, and also on 
account of the apprehension of cattle owners of this danger of spread of 
the disease, we decided that no inspection should take place this year. 

The next inspection will undoubtedly be ordered some time during 
the coming winter, and at the end of that inspection a much better general 
opinion of conditions of animals and premises can be rendered than at 
the present time. 

If, upon examination of the animals on a certain premises by an in- 
spector, he has reason to suspect the presence of any contagious disease, 
he is ordered to quarantine such animal or animals, and send duplicate 
copy of such quarantine to this office. 

I am enclosing to you a blank form used by the local inspector of 
animals at the time of their examination, in order that you may see the 
information they are expected to return to us. A copy of their report is 
left with the owner of the animal, another one retained by the inspector, 
and the full record sent to this office. At the time a copy of this record 
is left with the owner of the premises, such recommendations for im- 
proved conditions, if any, as are necessary in the opinion of the inspector, 
are brought to the attention of the owner by the inspector, and the 
owner is requested to make such improvements. A later visit is made 
by the local inspector, at which time, if conditions are found to be de- 
cidedly improved, the report submitted to this Department above re- 
ferred to credits the owner with the conditions found on the second visit, 
and in most cases we find that the owners carry out the recommenda- 
tions made by the inspectors. 

As a result, many of the cases that under a former plan would have 
been called to the attention of the district agents of our department 
are satisfactorily disposed of locally, but if not so disposed of our district 



56 



agent is sent to the premises, and this Department's supervision is directly 
given to such premises, and frequent visits made until they are placed 
in a satisfactory condition. 

All. cattle over six months of age coming into Massachusetts from 
any point without the State, if not intended for immediate slaughter, 
are according to law tuberculin tested by an agent of this Department, 
unless accompanied by a certificate of test made by a man approved 
by the officials of the State wherein the shipment originates. All animals 
reacting to this test are destroyed. 



For the Year ending Dec. 1, 1914- 
Number of cattle tuberculin tested by agents of this Department or ap 

proved veterinarians outside of the State were 
Released at Brighton, . 
Released at other points, 
Released for slaughter, 
Condemned at Brighton, 
Condemned at other points, 
Permit-to-kill warrant issued, 



23,645 

17,485 

5,472 

2 

587 

,86 

13 



The above figures relate only to cattle brought into Massachusetts 
from without the State. 

Of the 17,411 tested at the quarantine station in Brighton 587, or 3 J 
per cent., reacted to the tuberculin test, and only one of such reactors 
failed to show lesions of tuberculosis on post-mortem examination, which 
is made in every case. 

The following figures show the number of neat cattle quarantined by 
local inspectors of animals within the State, 'for which number warrants 
were issued by this Department, and disposition made of the animals: — 



Massachusetts Cattle. 
Total number of cattle quarantined or reported for examination during 
the year, . . . ... 

Number released, ....... 

Number condemned, killed and paid for, 

Number condemned and killed, in process of settlement, 

Number permit to kill, paid for, .... 

Number permit to kill, no award, .... 

Number died in quarantine, no award, 

Cattle from without the Slate. 
Number released, ........ 

Number condemned and killed, no award, 

Number condemned and killed, no lesions found, paid for, 

Number in process of settlement, ..... 



2,259 
288 
880 
141 

63 
174 

36 



12 

654 



In addition to the 2,259 head of cattle disposed of as above, 133 cattle 
and 27 swine have been reported by butchers, Tenderers and boards of 
health as having been found tuberculous at time of slaughter, all of 
which were rendered. 



57 

I quote you section 31, chapter 90, Revised Laws, as amended, which 
restricts the use of tuberculin as a diagnostic agent: — 

Tuberculin as a diagnostic agent for the detection of tuberculosis in domestic 
animals shall be used only upon cattle brought into the commonwealth and upon 
cattle at Brighton, Watertown, and Somerville; but it may be used as such diag- 
nostic agent on any animal in any other part of the commonwealth, with the 
consent in writing of the owner or person in possession thereof, and upon animals 
which have been condemned as tuberculous upon physical examination b3>- a 
competent veterinary surgeon. Such tests by the use' of tuberculin shall be made 
without charge to citizens of the commonwealth, and in all other caser the expense 
ol such tests shall be paid by the owners oi such animals or by the person in posses- 
sion thereof. 

The activities of the local insDectors of animals are not limited to 
their annual cattle inspection. On finding an animal which to them 
seems to be probably diseased, they quarantine the same, and return a 
duplicate to this office. A warrant or killing order is then made out, and 
one of our district agents, or an outside veterinarian who acts as our 
agent, is charged with the execution of the warrant. If, on physical 
examination the animal is found to be diseased, it is condemned and 
killed, and report made to this office of the lesions found on post-mortem 
examination. 

Following the disposal of a case of tuberculosis, the owner is required 
to disinfect the premises according to our instructions, and his claim 
for reimbursement for the death of the animal is not paid until report 
is on file in this office that the disinfection has been satisfactorily com- 
pleted. 

I am about to institute the practice of careful physical examination 
of all the animals in the herd from which an animal afflicted with tuber- 
culosis has been condemned by this Department. In my opinion this 
will bring to notice a no inconsiderable number of diseased animals which 
otherwise might have escaped notice for a greater or less period, during 
which time they were acting as spreaders of the disease. 

The percentage of Massachusetts cattle tested with tuberculin is 
necessarily small, and it is impossible to get at the correct statistics. 
This Department tests Massachusetts cattle with tuberculin only upon 
voluntary request of the owner, and private tests which are made are 
not in very many cases reported to this office, so that no means are at 
hand for obtaining information as regards the percentage of the State's 
cattle which are tuberculin tested. 

Whether or not a tuberculin test should be compulsory is a large 
question, and open to a great deal of argument pro and con. Compulsory 
tuberculin test was inaugurated in this State some twenty years ago, 
but it was not carried very far before the farmers rose en masse against 
it. Tuberculosis was then so rampant among the cattle of this State 
that in many instances as high as 30 to 50 per cent, of the cattle were 
destroyed as a result of the tuberculin test, and the carcasses became 
a total loss. 



58 

In my opinion there is a gradual improvement from year to year in 
the percentage of cases of tuberculosis among our cattle, and with what 
improvements we make in the control of this disease I think the general 
situation is found to gradually become better. 

On the appearance of foot-and-mouth disease in this State last Novem- 
ber the great market for milch cows, viz., Brighton Stock Yards, was 
immediately closed, and remained closed until Sept. 1, 1915, when modi- 
fication of the quarantine was allowed, so that there could be received at 
these premises cattle from the States of Massachusetts, Maine, Vermont 
and New Hampshire. Cattle from all other States in the Union are 
prohibited from entering the Brighton Stock Yards unless intended 
for imm ediate slaughter, and all cattle received from any other sections 
of the country than those States mentioned are obliged to remain in 
quarantine at the point of arrival until released by an agent of this De- 
partment, and at the present time this limit of quarantine is fifteen days, 
so that in case the animals have picked up this infection en route, sufficient 
time will elapse while in quarantine for them to show clinical symptoms, 
and the disease will therefore be confined to those premises. No cattle 
are received anywhere in Massachusetts from any point other than what 
is designated as "free area" by the United States Department of Agri- 
culture. All premises on which foot-and-mouth disease existed during 
the recent epidemic are still under quarantine, and animals go to and 
from such premises only on permit of this Department. 

Regarding the health of cattle in different sections of the State, a 
larger number of cases of disease are found in the middle and eastern 
sections. Very little contagious disease of any kind is found in the Cape 
district, and in that portion of the State west of the Connecticut Biver. 

As you asked for a personal opinion regarding physical examination 
of animals, I would say that it is my belief that a more careful and more 
frequent physical examination would certainly tend toward an improve- 
ment in the health conditions as viewed from the standpoint of the 
products of the animal industry, whether that product be milk or meat. 

Very truly yours, 

Lester H. Howard, 
Commissioner. 

I. CATTLE BREEDERS' ASSOCIATIONS. 

Appended is a list of the replies from several cattle breeders' 
associations in response to request for information as to their 
opinion on the question of selling milk on a basis of its food 
value. 

Mr. Williams attended a meeting of the New England Hol- 
stein Friesian Breeders' Association, and asked for an opinion 
on the matter of selling milk on a basis of its food value. The 



59 

members of the association would not give a frank opinion, 
but two or three members said that the association had always 
stood for clean, pure milk. Mr. Williams was led to believe 
that they were opposed to any system whereby milk would be 
sold on a basis of its food value. Several of the members made 
claims that Holstein milk was a better milk for infants or in- 
valids than any other, and that it was the best substitute for 
mother's milk that could be found. Professor Hills in an ad- 
dress at the meeting said that he had carried on a great number 
of experiments, and had come to the conclusion that Holstein 
milk was the nearest to the ^sea^t- milk for infant feeding, 
but was no better than Jersey or Guernsey milk that was re- 
duced to the same amount of fat, solids, sugar, etc. Professor 
Hills said that his experiments had been carried on on a large 
number of baby pigs. 

No answer has been received from the American Holstein 
Friesian Association in response to our letter, as the secretary 
could not say how they felt in the matter, but he said he would 
take it up at some future- meeting. All of the other associa- 
tions that have answered have expressed their approval of the 
idea of selling milk on a basis of its food value. 

As far as the Jersey breed of cattle is concerned, nothing would please 
us better than to see milk universally sold in accordance with its value . 
as food. (American Jersey Cattle Club, R. M. Gow, Secretary.) 

There is no question about the desirability of selling milk on the basis 
of its food value. Brown Swiss Breeders are in favor of a quality test 
on milk. (Brown Swiss Breeders' Association, H. C. Taylor, Secretary.) 

The question has never been discussed by the Ayrshire Breeders' 
Association in relation to selling milk on its food value. My personal 
opinion is that milk should be sold on the food value it contains. (Ayr- 
shire Breeders' Association, C. M. Winslow, Secretary.) 

I am personally a great believer in the selling of milk and dairy products 
according to their value as food. Why should not the same be done as 
with other commodities? (American Guernsey Cattle Club, W. H. 
Caldwell, Secretary.) 

I was always of the belief that all dairy products should be sold as 
nearly as possible on their basis of food value. (Bed Polled Cattle Club, 
H. A. Martin, Secretary.) 



60 



PART III. FACTS OF PRODUCTION, PROCESSING AND 
MARKETING. 



A. SUMMARY OF MILK BOARD'S OWN DAIRY INSPEC- 
TIONS. 

The Milk Board visited various sections of Massachusetts, 
Maine, New Hampshire, Vermont, Connecticut and New York 
and the Province of Quebec in their investigation of the milk 
problem as it pertains to the State of Massachusetts. More 
than 300 dairies were investigated, and although this number 
represents approximately only 2 per cent, of the total number 
of dairies within the State, their location and type make them 
reasonably representative of the whole. The committee started 
its work in the Berkshire section of the State in April, 1915. 
In May 33 dairies were investigated in the following towns: 
Truro, North Truro, Orleans, East Orleans, Eastham, Barn- 
stable and Sandwich. There were a total of 146 cows kept on 
these dairies, producing approximately 1,429 quarts of milk per 
day. The farms were on the average neat and clean. Many of 
the barns were old but kept in reasonably good condition. Only 
in one or two instances were they of a low standard. Cooling and 
icing were done in a fairly satisfactory manner. Several farmers 
state that there is no demand for winter milk, and are consider- 
ing the keeping of cows only for the summer trade. The aver- 
age price for milk at wholesale is 6 to 7 cents per quart, and 
at retail, 10 to 12 cents per quart. Some dairies sell at the 
door for from 7 to 9 cents per quart. Mr. P., a small producer, 
wholesales at 6 cents per quart, and says that "there is no 
money in the business." Another dairyman who retails his 
product says that the business pays only when milk sells at 10 
cents. There were four herds in this section tuberculin tested. 
Dairies were subject to local and State inspection, and no com- 
plaints were heard regarding it. Fifteen dairies in Truro, sup- 
plying milk to Provincetown, were inspected and scored, the 
old form of score card being used. For methods they averaged 



61 

73 of the perfect score and for cleanliness, 72. Two instances 
were noted where former inspection by the State Department 
of Health had been of service. A man who owned the dairy 
which gave the highest score stated that the conditions found 
were due to suggestions made by the inspector of the Depart? 
ment. Another who had been annoyed with moisture collecting 
upon the ceiling and falling down said that upon advice of the 
inspector of the State Department of Health the condition had 
been removed. Conditions of the dairies in this part of the 
State are rather different than those elsewhere. There are fewer 
cows, and milk is as a rule delivered to consumers by the owner 
of the dairy immediately after milking, and very frequently 
without cooling. 

The district visited about Lynn included this city and Saugus, 
Melrose, Lynnfield, Peabody and Salem. Thirteen dairies were 
visited. A total of 462 cows were kept. The conditions in gen- 
eral were good. Poor drainage conditions were noted in two, 
and a few did not have separate milk rooms. On several dairies 
only a few cows were kept principally for the purpose of pro- 
ducing fertilizer. Such places were engaged in market garden- 
ing, the dairy end being more or less a side line. On one of 
the places the cattle were regularly inspected by veterinaries, 
and the men employed subjected to physical examination by 
physicians. Milk retails for from 7 to 12 cents per quart, and 
wholesales at 45 to 50 cents per can in winter and from 42 
to 43 cents in summer. Mr. B., who has 18 cows, says there 
is no money in the business at these prices. Mr. S., having 
50 cows and selling milk at 8 cents retail, says the milk busi- 
ness is not so profitable as it used to be because grain and cows 
cost so much. In Methuen, Bedford and Concord 9 dairies 
were visited, with a total of 375 cows kept. The conditions 
found were generally satisfactory. Milk from these dairies re- 
tails for from 8 to 12 cents per quart. Mr. B., producing 160 
quarts daily, all of which he retails at 8 cents per quart, said 
that the milk should bring 9 cents per quart to make the busi- 
ness a paying proposition. All these dairies and those included 
in the Lynn district are subject to local and State inspection. 
There appears to be no objection to such inspection; no com- 
plaints were made. Mr. H., who keeps 50 head of cattle and 



62 

produces 300 quarts of milk daily, said that proper inspection 
would be a good thing if the inspector understood the farmer's 
problem. Representatives of the committee visited the district 
about Fitchburg, which included, beside the city, the towns of 
Westminster and Winchendon. Eight dairies were visited upon 
which were kept a total of 205 cows, producing approximately 
1,509 quarts of milk daily. One of the dairies produced cream 
and wholesaled in the city of Fitchburg. All the dairies visited 
presented very satisfactory conditions. They were subject to 
frequent local inspection, which was based upon education 
rather than coercion. Commendable conditions were noted on 
dairies in Winchendon. Only two dairies wholesaled their milk 
and one wholesaled cream. The prices received by these dairies 
were 40 cents per can for milk and 50 cents per quart for 
cream. Milk retails in Fitchburg for from 8 to 12 cents per 
quart, while in Winchendon the maximum is 8 cents per quart. 
Mr. M. of Winchendon, whose methods and equipment gave an 
excellent score, 93, thinks that 10 cents per quart would be a 
fair price. 

In the Berkshire district which included Richmond, West 
Stockbridge, Great Barrington, Egremont, New York State, 
Stockbridge, Pittsfield and Cheshire, 15 dairies were visited, 
also one creamery keeping 333 head of cattle and 33 young 
stock. In many of the farms visited conditions were found to 
be fairly good. Some in addition to dairy farming were en- 
gaged in various side lines, such as poultry, pork raising and 
summer boarders. Milk from this section is shipped into Pitts- 
field, Mass., and New York. Mr. S., who operates a 100-acre 
farm, retails the milk at 8 cents per quart. He says that were 
it not for the fact that he and his wife do all the work he 
could not stay in the business. One of the troubles he says 
has been multiplicity of inspection. A Mr. C, operating a 
200-acre farm, says that milk should bring 5 cents per quart 
at the farm in order to pay. Butter produced in this section 
brings at retail 35 to 40 cents per pound. Mr. M., who has 
a 275-acre farm and is engaged in this business, states that 
butter could not be produced for less than the prices given and 
allow a living margin. The dairies are subject to local inspec- 
tion. , Inspectors also come in from Pittsfield and New York 
to dairies supplying milk to these places. 



63 

The committee visited 80 dairies in the Deerfield valley, in- 
cluding the following towns: Ashfield, Buckland, Conway, Shel- 
burne,. Charlemont, Heath and Whitingham, Vt. 

The dairies were found to be in a very poor condition. On 
a total score, 10 per cent, scored below 40 and only 1 per cent, 
above 70. The Milk Inspection Association had recommended 
that permits be refused to any dairies scoring below 50. Nearly 
all the dairies use ice for cooling. The milk is kept in 40- 
quart cans, and is collected every day, or every other day in 
some cases, and delivered to the railroad depot, where it is 
kept without being iced until placed on the train. . Some of 
the farmers are obliged to cart their milk some distance and 
leave it on the platform in the sun until the collector calls for 
it. A number of Polish people have bought up old farms in 
this region and are gradually improving them. One of these, 
for example, presented dirty walls and floors, with manure 
piled up to the windows. This place scored 48.7, but the use 
of ice in milk house brought up the score. On another place 
presenting dirty conditions the woman who was interviewed 
stated that she knew the stable was in poor condition, but the 
price given for milk was insufficient to compensate for making 
any improvements. She also stated that the Pole who col- 
lected the milk was in the habit of measuring it by means of 
a stick which he wiped sometimes on a cloth, sometimes on 
his overalls and sometimes on the grass. The average price 
paid the farmers is $1.55 per 100 pounds, which is undoubtedly 
less than the cost of production, and out of this is deducted 
the cost of transportation. One farmer stated that the reason 
for the low price of milk was due to the inability of the farmers 
to hold together. Very few of the farmers keep more than 10 
cows. They keep only a sufficient number, to enable them to 
keep up the farm, the principal product being manure and the 
by-product being milk. Inquiries relative to any systematic 
inspection being made met with negative replies. The only 
inspection is that casually done by the man representing the 
milk contractor at the time he makes his visits to solicit milk 
from the farmers. The character of some of these dairies war- 
rants the statement that the contracting company is willing to 
take milk from any dairy, no matter what condition it is in. 
Dairies were visited by the committee in the towns of North 



64 

Charlestown, Claremont, Greenville, Mason, all in New Hamp- 
shire, and Wethersfield, Vt. Thirteen dairies were inspected 
on which were kept a total of 150 cows, producing approxi- 
mately 131 cans of milk per day which was shipped into the 
State of Massachusetts. A few places presented fairly good 
conditions, while in others various objectionable conditions pre- 
vailed, such as poor barns, lack of proper milk rooms or suit- 
able places to handle milk, poor methods of cooling and low 
standard of cleanliness. Milk is wholesaled at 25 to 32^ cents 
per can. A Mr. M., producing 8 cans of milk per day, says 
that the laws discourage milk production. 

Seven dairies at Wethersfield, Vt., were visited, where a total 
of 149 cows were kept, producing 550 quarts of milk per day, 
all of which was shipped into Boston, Mass., to a milk con- 
tractor. Conditions on each dairy were distinctly bad. The 
place in which the cows were kept was unfit because of filthy 
and wretched drainage, poor light and ventilation and general 
filthy conditions. Some of the most filthy conditions of all 
were found on the milk collector's farm, this man being em- 
ployed by the contracting company to collect the milk from 
the farmers and ship it to Boston. Farmers complained of 
delay in collecting and shipping the milk, one farmer stating 
that the milk was thirty-six hours old before it was shipped 
from Claremont. The price paid the farmers for milk ranged 
from 28 to 33 cents per can. One farmer preferred to sell his 
milk to a local creamery. The wife of a dairyman, in his ab- 
sence, stated that her husband did not consider there was any 
money in the business at the price they were getting. Others 
were going out of business because of the low price received. 
The committee were of the opinion that milk from this region 
should not be permitted to enter Massachusetts or any other 
State as conditions now exist on the farms. 

The committee visited 27 dairies in the counties of Andros- 
coggin, Cumberland, Kennebec, Lincoln, Sagadahoc and Waldo, 
Me.; also visited the plants of the milk contractors in this 
region from which milk is shipped into Massachusetts, the prin- 
cipal one of which is the Turner Center Dairying Association. 
Of the 27 dairies visited, 22 sold to this association, 4 to two 
Massachusetts contractors and 1 to the Bangor Creamery. The 



65 

dairies supplying the Turner Center Dairying Association were 
found to be in the best condition, while those supplying the 
Massachusetts contractors presented nasty conditions; horse 
manure was used in gutter, and milk was found cooled in tub 
of water near pump in hot weather and was not cooled at all 
in cold weather. The pasteurizing plants were found to be in 
a very good sanitary condition, and conducted on the whole in 
a satisfactory manner. The plants visited were located at Au- 
burn, Wiscasset, West Benton and Unity. The pasteurizing 
plant of one of the Massachusetts contractors at Unity was 
in an extremely dirty condition. Pasteurization in this plant 
is supposed to be carried on at a temperature between 160 to 
170, and the cream is held for thirty minutes, while skimmed 
milk is not held. The temperature at the time of visit regis- 
tered 172. 

The Turner Center Dairying Association has the total output 
of between 4,200 and 4,300 farms situated in Maine. Of this 
amount, 75 per cent, is sold in Massachusetts. Very little is 
sold at retail in Massachusetts except in the city of Lawrence. 
Mr. Bradford, manager of this association, believes that pay- 
ment on a butter-fat basis has a tendency to make farmers 
produce milk very high in butter fat. The price of butter fat 
is fixed from time to time. They also purchase by hundred- 
weight of milk, and give a bonus of 1 cent per pound of butter 
fat for milk from tuberculin tested herds. Mr. Bradford 
thought the average retail price for bottled milk in the larger 
cities of Maine was 8 cents per quart, while in smaller places 
it was as low as 6 cents per quart. The average price to the 
farmer in the State of Maine, he presumed, was 3| to 4f cents 
per quart. 

A farmer selling to the Turner Center Dairying Association 
stated that he makes a profit of at least $250 per year from 
milk alone from 10 cows. Nearly all dairymen interviewed 
were of the opinion that they did not lose any money on their 
milk. One criticized the method of selling, as he was obliged 
to take the word of the Dairy Association as to the weight and 
fat contents of his milk. 

All the product of the Turner Center Dairying Association 
is pasteurized. Pasteurization is done at creameries in Maine. 



66 

The milk is subsequently bottled in Boston at the point of 
shipment. Milk received at one of the plants of a Massachu- 
setts contractor at Etna, Me., was not pasteurized. It was 
received at the station, placed in cans in ice water, and shipped 
on the train the following morning, arriving in Boston at 4 or 

5 P.M. 

The committee visited the Province of Quebec to look into 
dairies shipping milk and cream into Massachusetts by way 
of Newport, Vt. The business of shipping milk at this point 
has gradually grown during the few years it has been in opera- 
tion until at the present time an average of 250 40-quart cans 
or jugs of milk and cream are sent out every night. In addi- 
tion to this section it was learned that there were three other 
distinct sections in the Province of Quebec from which milk 
and cream were sent into Boston, viz., by the Passumpsic 
Division of the Boston & Maine Railroad; a triangular area 
with apex at St. Albans, Vt.; and a branch road north of the 
Grand Trunk line, connecting with the main line running from 
Montreal to. Portland, Me. It appeared to the committee that 
the various milk contractors were trying to keep the milk and 
cream during transit in as good condition as when received. 
Two methods of cooling were in operation during transporta- 
tion, — the iced car and blanketing. Inspection of one of the 
contractor's creameries located at Newport, Vt., showed that 
the conditions did not compare with those existing in the same 
company's plant in Massachusetts. The price paid at Newport 
station for cream is 32 cents per pound of butter fat, and for 
milk, SI. 60 per 100 pounds of milk. The prices are based upon 
a sliding scale from month to month. Twenty-seven dairies 
were inspected in this region, 13 of which shipped their milk 
into Massachusetts. The sanitary conditions on the various 
farms compared very favorably with conditions found in dairies 
located in New Hampshire, and were very much better than 
those noted in the dairies visited in Vermont. At the time of 
visit they were being inspected by a representative from the 
United States Department of Agriculture. Through his efforts 
many improvements were being made on the different farms. 
A good many of the farmers in this region are engaged in rais- 
ing young stock for beef, and make use of the skimmed milk 



67 

for this purpose. One farmer stated that he did not consider 
there was much money in selling cream, but the skimmed milk 
disposed of in this way helped out. The dairies in the vicinity 
of Lyndonville, Vt., supplying the Lyndonville Creameries Asso- 
ciation, were investigated in company with the board of health 
of the city of Newton. These dairies were found to be in a 
most unsanitary condition, the score for cleanliness of stable 
being very low. In some instances the separators were placed 
directly behind the cows in the open barn. It was also a com- 
mon practice to have privies in the stables. In many instances 
the milk was kept twenty-four hours in a tub of water in the 
stable, the covers of the cans being generally partly removed. 
From the foregoing summary we may conclude (1) that al- 
though the dairies in Massachusetts as represented by those 
visited, except dairies in the Deerfield valley, are reasonably 
satisfactory, the conditions vary somewhat io different sections, 
and (2) that dairies in New Hampshire, Vermont, Maine and 
the Province of Quebec do not reach the same standards as 
those in Massachusetts. A few deductions showing the differ- 
ences follow: — 

Dairies in Cape Cod section, while having barns that are old. and 
methods and equipment not as modern as are found in other sections, 
are nevertheless well kept, neat and clean. 

Dairies about Lynn and Methuen have somewhat better conditions 
as to structure and equipment. In this section are examples of the best 
conducted and equipped dairies. One of them requires regular inspection 
of the cattle by veterinaries, also medical inspection of the men employed. 

Dairies about Fitchburg and Winchendon presented commendable 
conditions. Dairies in Winchendon, examples of the average old farm, 
have been brought up to an excellent sanitary condition, with good 
separate milk rooms, proper cooling facilities and equipment for the 
sterilization of milk utensils, etc., through a local system of educational 
inspection. 

Dairies in the Berkshire district are not as well kept as in other sections. 
A number of them engage in other lines, such as raising pork, poultry, 
keeping summer boarders, etc., so that the dairy end failed to receive 
the proper attention. 

Dairies in the Deerfield valley presented filthy conditions. The farms 
are run down and are being bought up by Polish people who are gradually 
improving them. Only a few cows are kept on each of the different farms, 
principally for fertilizer, the milk apparently being a by-product. 



68 

Dairies at Wethersfield and Lyndon ville, Vt., presented the most 
filthy conditions of any visited out of Massachusetts. Drainage con- 
ditions were such as to render the places unfit for the housing of cattle. 
Facilities for the handling of milk were entirely inadequate. Nasty 
methods of cooling the milk were used. 

Dairies in Maine shipping to Massachusetts contractors were in much 
worse condition than those supplying the local dairying association. 
Horse manure was used in the gutters and careless and nasty methods 
of cooling the milk prevailed, such as cooling in the tub from which 
cattle drank. 

Dairies in New Hampshire have poor cow barns, lack of suitable milk 
rooms, crude methods of cooling the milk, and rather low standard of 
cleanliness. 

Dairies in the Province of Quebec presented fair conditions. Im- 
provements in some were being made. They lacked suitable milk rooms 
and proper facilities for cooling. Cows were housed in the cellars of the 
barns because of the extreme cold in winter. 

A summary of the scores of the dairies inspected on these 
trips is given in the following table : — 



69 



.??h 



CO 









H 




o 


US 


CM 


CO 


^ 


, o 


© 


H 3 En 


© 


rH 


cm 


CO 


■* 


' co' 


H 


Dairi 

NEAR 
DONVI 
ERMON 


<< 02 
































„°..s 


o 


co 


lO 


t^ 


00 


r~ 


© 


3! P> 


<£f§ 




IM 


o 




CO 


CO 


© 


»o 




CM 








o 


hj 


oP 
















H 
oi IS 

S w s«' 

P3 to H 


6 a, 8 


1 


O 


CM 

CM 


CM 

CO 


CO 


1 1 


CO 


3 w as 


















M °s 




CO 


CM 


CO 


CO 




© 


n fflO 


^■s.S 








US 






o 


N ^ 


f^ga 
oP 






CM 


■* 


CM 




o 


M 
















2^ 

03 O O 
M H H 

S H H 


S 8,2 

One 
< 02 


1 


CO 


CM 


CO 


CO 


K5 


CO 






































■«! 15 < 
















o 


P ^> 
1-1 o 

on 

GO V -' 


CD +a'C 


1 












© 


oP 








CO 






© 


g 
CO ■ 


a) 8, >h 


1 


o 


CO 


CO 
CO 


CM 


1 1 


00 
CM 


S5 


































pS 




1 




CO 


■* 


H5 

CO 


1 1 


o 
© 


CM 


oP 






CM 


CO 






© 


ood's 

IBS 

FIELD 

BY. 


III 

J2 c3 o 
<< 02 


o 

o 


CO 


CO 

CM 


CO 
CO 


■* 


« ' 


© 

CM 


WSS3 


















MH • 
















*£%^ 








CO 


CO 




00 


© 


oQQ|> 


O HJ'Cl 














o 


° Iz 
oo S 


PHgS 

oP 


<M 


CM 


CM 








CD 


26 of Childs 
& Barrows' 
Dairies in 
New Hamp- 
shire and 
Vermont. 




o 




. 


CM 


CO 


o © 


CM 




o 




CM 


CO 


■* 


W5 CO 


CO 


















oP 


CM 

OS 


1 


tM 

0> 


lO 


w> 


CM lO 
CM TH 


© 

o 
o 


of Hood's 

Dairies, 
ittsfield, 
ew Hamp- 
shire. 


<3 a, 2 
> 5?° 

"2 03 o 
•< 02 


1 


1 


CM 


1 


CM 

"di 


° 1 


•cH 


















O S 

M • ■-'< 


1 


1 




I 


* 


d ' 


© 


a ^ 


Pm g'S 

c3p 














© 




go2 

8 MO 
J2 c3 o 




C3 




CD 


to 


CM © 


■d" 


a to 

Cm a 




- 1 




CO 


■cH 


id © 


■* 


o 2 


















HH ■ 
















s^ 


U .-8 

d> HJ frH 

P* g'3 

6p 


1 


CO* 


1 


CO 

CO 

CM 


o 

o 
-* 


O t— 

© CD 


o 

o 
o 


to 


















8 


















» 






















































OD 
















M 
< 






o 


rt 


CM 


CO 


Ti< 


t£i © 





70 



'-3 

a 
o 
u 



CO 

s 



QQ 



3 
&Q 





e 


<3 8.2 

S Mo 


o 


o 


o 


r- 




CO 




Dairies 
near 

DONVILL 
BRMONT. 


o 


'- , 


CM 


co 




o 




<** ■ 
















h°..S 


00 


CM 


«o 


«s 




o 




l-l 


^g-a 

oQ 


00 


OS 


«* 


■* 




o 
o 




H 

5 S t» 

K m n 


>2 

5 Mo 
_2 cj e> 


o 
o 


CO 


CO 
CM 


o 


CM CM 

T* lO 


o> 




^ « D 


















o g 
















Qbo 


to 


r-- 


■* 


CO 


— * CO 


o 




ccHO 


^"SlS 












o 




N Z 


fcga 


CM 


CM 


eo 






o 






oQ 
















" p 

■Dgk.' 


S s, 2 

S MO 
"< 02 


o 
o 


CM 


o 

CM 


CO 


o o 


"Cf 




-C fc 3 


















^ o g 
















1-1 o 

SO 


ffl-p tl 












o 




Png-3 


CO 


<M 


CM 






o 






OQ 
















a 


» 8,2 


o 


CM 


CO 


CO 




CO 




35 . 


2 S o 
<! 02 


o 


y-i 


CM 


CO 




co 




H H 
















S2 


















s2| 

<Sg-3 


to 


00 


o 

CO 


t» 


1 1 


o 
o ■ 




t— 


lO 










o 




Hood's 

iries 

erfield 

LLEY. 


Sog 


o 


•<# 






o 


■* 


09 


J2 C3 o 
< 02 


o 


rt 


CM 




.* ' 


*-' 


















g 


<«-. • 














U5 


oQP> 


f^g-a 


CM 


U5 


o 


1 


2 1 


o 




oo a 


CM 


CO 


Tt< 






o 




































Childs 
rrows' 

tIES IN 

Hamp- 
e and 

MONT. 


a> 8,2 


O 

o 


•* 


CM 


o 

CO 


[ 1 


CO 

o 




-< 02 
















































26 of 
& Ba 
Daii 

New 

SHIR 

Ver 


*°..l 


t~ 


•o 


O 


00 




o 




^g-a 


lO 


3 


r-~ 


CO 




o 
o 






oQ 
















to , 


o 8 2 

S MO 
<! 02 


o 




CO 


o 








a -at 


o 




CM 


CO 




CM 




o a h <! a 
















ffiSEMg 


































1 OF 

Dai 
Pitts 

few 

SH 


O <n 
o -g.jj 


CM 

OO 


' 


e» 


CM 


1 1 


o 

o 

o 






OQ 


















o 8,2 

S MO 

J2 ci a 

<! 02 


o 




CO 


CO 


CM O 


r~ 






o 




CM 


CO 


■* "5 


CM 




P. H 
















ds 


















n°J 
















2P 


o 




t~ 


r~ 


CO CO 


o 




oQ 


o 


' 


CO 


CO 




o 






CM 








"5 i-H 


o 




















to 


















H 


















(3 






















































02 














1 

< 




* 






















o 


« 


cm 


CO 


■* to 









o 








l~ 








CO 






1 


CM 

1 
1 


1 




1 
1 


1 
1 


1 

1 

o 






*■- 


e» 






t. 


CO 






CO 


CO 












„ 




' 


' 


o 










s? 








<a 








s 








w. 


1 


1 












a 








§ 


1 
1 

1 


1 

1 

1 


1 
1 

1 




t 

1 
I 


1 


1 

1 
1 




•* 


X 


CM 




o 


■A 


CO 



71 



14.9 
17.0 
21.0 

32.7 
38.0 


-*' 


40.8 
47.8 
4.5 

2.3 
2.3 


o 
o 


14.6 
17.8 
21.7 
24.1 

36.7 


o 
o 


22.7 

40.9 

22.7 

4.6 

9.1 


o 

o 

o 




14.0 
17.0 
22.0 
25.0 


IM 


37.5 
42.5 
10.0 
10.0 


o 
o 

o 




14.5 
17.6 
22.2 
26.6 


■* 


22.5 

48.1 

18.5 

3.6 


o 

o 

o 


14.0 
17.0 
21.0 
24.0 
32.0 


to 

to 


32.5 

48.7 
8.8 
2.5 
1.2 


o 

o 
o 




15.5 

18.5 
21.2 


oo 


3.8 
57.7 
38.5 


o 

o 

o 




18.7 
22.1 
25.7 
28.1 


lO 

<M 

CM 


27.3 
36.4 
27.3 
9.0 


© 

©' 

o 




15.4 
18.8 
22.6 

25.7 
29.0 


to 

CM 


6.7 
20.0 
53.3 
13.3 

6.7 


o 

o 

o 






12-16, . 
16-20, . 
20-24, . 
24-28, . 
28-32, . 
32-36, . 
36^0, . 


to 
M 
cd 

u 

% 

< 



6.0 

23.1 
27.5 
32.6 
38.0 

50.2 


IM 

CO 


2.3 

6.7 
13.6 
52.4 
20.5 

4.5 


o 

o 
o 


26.5 
32.9 
40.5 
43.8 


CO 


50.0 

36.3 

4.6 

9.1 


o 
o 
o 


27.0 
33.0 
37.0 
43.0 
49.0 


o 

CO 


17.5 

52.5 

22.5 

6.2 

1.3 


o 

o 
o 




13.6 
22.0 
25.9 
33.2 
38.2 
44.1 


■* 

** 


3.7 

7.4 

22.5 

7.4 

37.0 

22.0 


o 

o 
o 




21.0 
27.0 
33.0 
39.0 
44.0 
52.0 


o 

CO 


2.5 
13.7 
37.5 
26.3 
17.5 

2.5 


o 

o 

o 




29.4 
33.4 
39.1 
44.0 
48.5 


CO 


3.8 
46.3 
30.8 
11.5 

7.6 


o 

o 

o 




29.7 
34.1 
37.9 


to 

CO 


_ 

9.1 
28.3 
62.6 


o 

o 

o 


to to t- CO to 


to 


CO to i* Oi ^ 
CO CO ^ •& lO 


CO 


1 1 1 1 1 - "■ "*■ °- m . 


o 


O CO CO O CO 
CM iH CO tM i-l 


o 
o 












CD 

If 




> 


0-6 
6-12 
12-18 
18-24 
24-30 
30-36 
36-42 
42-48 
48-54 
54-60 


< 



72 



« 

Pi 

o 
O 



CO 



5Q 






I 





44 Dairies 

near 

Lyndonville, 

Vermont. 


<u 8 t, 
>MO 

<! co 


13.0 

37.6 
46.1 
52.8 
61.0 

85.7 


lO 

csi 






co-if'E 

OP 


2.3 

9.2 
40.8 
40.8 

2.3 

4.6 


o 

o 
o 






CO « 

SB* 

« 03 &H 

sua 
^ « & 

HBO 

CC.MO 

N ,g 


» 8,2 

£ Mo 

2 oj <a 

<! to 


42.9 
53.3 
63.5 
71.1 

82,2 


o 






(Sg| 


50.0 
31.7 
9.1 
4.6 
4.6 


o 

o 
o 






15 B 

M p 

« S M 
M H H 

E o j 

«! S5 3 

Q *> 
M cr 

on 

oo v "' 


© 8,2 

S MO 

<! co 


38.0 
48.0 
53.0 
65.0 
73.0 


o 

«5 






ofl 


2.5 
45.0 
37.5 
12.5 

2.5 


o 

o 

o 






27 Dairies in 
Maine. 


o3 8, <- 

> of 8 
<! co 


25.2 
39.4 
43.9 
54,5 
64.1 
70.0 


o 

CM 

in 






Per 
Cent, of 
Dairies. 


7.4 

7.4 

22.2 

33.3 

26.0 

3.7 


o 

o 
o 












« 

O 

o 
so 

o 


80 of Hood's 
Dairies 

in Deerfield 
Valley. 


© s, 2 
r; o3 o 
■< CO 


36.0 
46.0 
54.0 
63.0 

87.0 


CM 

•a 




6 2-i 

<Sg-3 


8.8 
27.5 
38.8 
23.7 

1.2 


o 

o 

o 




26 of Childs 
& Barrows' 
Dairies in 
New Hamp- 
shire and 
Vermont. 


5 ft. B 
V«8 


49.6 
54.8 
63.5 
70.0 


00 

CO 

»T3 






* "S fa 

Ag-3 

ofl 


19.2 

50.0 

27.0 

3.8 


O 

o 
o 






11 of Hood's 
Dairies, 

PiTTSFIELD, 

New Hamp- 
shire. 


cb 8,2 

Ji 03 o 
<i CO 


48.6 
56.7 
63.1 


00 






*> "S fa 

A<g;s 

ofl 


9.0 
45.5 
45.5 


o 

o 
o 






H to 

- m 

* a 

,3(3 


CO ft 2 
_5 03 o 

<! co 


48.9 
55.9 
65.3 
72.8 
84.0 


CO 

CO 






-31 

® ti fa 
© s 

ofl 


6.7 
20,0 
26.6 
40.0 

6.7 


o 

o 

o 






to' 

B 
K 
O 
a 

CO 
















o 
M 
03 
M 

a 

> 

< 












- 






0-10 
10-20 
20-30 
30-40 
40-50 
50-60 
60-70 
70-80 
80-90 
90-10 





73 



B. COMPILATION OF MILK CONTRACTORS' STATEMENTS. 
A circular letter of inquiry was sent to the following milk 

dealers doing business in Massachusetts: — 

Alden Brothers, 1171 Tremont Street, Boston, Mass. 

C. Brigham Company, 158 Massachusetts Avenue, Cambridge, Mass. 
W. D. Cowls & Son, North Amherst, Mass. 

Deerfoot Farm, 9 Bosworth Street, Boston, Mass. 

Elm Farm Milk Company, 19 Wales Place, Dorchester, Mass. 

W. A. Graustein, President, Boston Condensed Milk Company, 134 

Cass Street (?), 484 Rutherford Avenue, Charlestown. 
H. P. Hood & Sons, 494 Rutherford Avenue, Boston, Mass. 
Manley Dairy Company, Brockton, Mass. 
A. D. Perry, Worcester, Mass. 

Plymouth Creamery, 268 State Street, Boston, Mass. 
H. H. Prentice, Pittsfield, Mass. 
J. B. Prescott, Bedford, Mass. 
Tait Brothers, Springfield, Mass. 
Turner Center Company, 63-69 Endicott Street, Boston, Mass. 

D. Whiting & Sons, 590 Rutherford Avenue, Boston, Mass. 

The letter requested information upon the following points of 
the business: — 

1. The quantity of milk and cream sold. 

2. Name of Massachusetts cities and towns in which milk is sold. 

3. Approximate proportion produced in individual New England 
States, New York and Canada. 

4. Details as to pasteurization. 

5 and 6. Details as to dealers' system of dairy inspection. 
7, 8 and 9. Requests for contractors' opinions on certain aspects of 
the milk business. 

The answers to these last three questions have been discussed 
elsewhere. 

A few weeks after first sending out the circular letter it was 
learned by accident that one of the contractors had never re- 
ceived this letter, or that it was never referred to the respon- 
sible officer of the firm. A second letter was then sent by 
registered mail to those who had not previously replied. This 
brought several prompt responses. 

Up to November 30 the follqwing dealers have replied: — 

1. Alden Bros., Boston, Mass. 

2. C. Brigham Company, Cambridge, Mass. 

3. Deerfoot Farm Dairy, Boston, Mass. 



74 

4. A. D. Perry, Worcester, Mass. 

5. Plymouth Creamery, Boston, Mass. 

6. H. H. Prentice, Pittsfield, Mass. 

7. J. B. Prescott, Bedford, Mass. 

8. Tait Bros., Springfield, Mass. 

9. Turner Center Dairying Association, Auburn, Me. 

10. D. Whiting & Sons, Boston, Mass,. 

11. H. P. Hood & Sons, Boston, Mass. 

No replies have been received from the following : — 

1. W. D. Cowls, North Amherst, Mass. 

2. Elm Farm Milk Company, Boston, Mass. 

3. W. A. Graustein, President, Boston Condensed Milk Company, 

Charlestown, Mass. 

4. Manley Dairy Company, Brockton, Mass. 

The following is a summary of the replies received: — 

Question 1. — Approximately how much milk and cream per annum 
do you sell? Wholesale? Retail? 

For trade reasons most of the dealers declined to state ex- 
actly how much milk or cream they now handle. Two or three 
of the smaller dealers and two large contractors gave exact 
figures. 

The Boston contractors report that their product is sold in 
Arlington, Belmont, Boston, Brookline, Brockton, Cambridge, 
Chelsea, Cohasset, Everett, Hull, Maiden, Marlborough, Med- 
ford, Melrose, Newton, Quincy, Revere, Somerville, Southbor- 
ough, Stoneham, Winchester, Winthrop, Woburn and Worcester. 

Cream is also distributed in addition to the above localities 
in the following places: Abington, Attleboro, Amesbury, Barn- 
stable, Fall River, Foxborough, Gloucester, Hanover, New Bed- 
ford, Provincetown, Maynard and Wareham. 

Tait Bros, of Springfield report that their output is sold in 
Springfield, West Springfield, Holyoke, Chicopee and titchburg. 

Question S. — Approximately what proportion of your milk and cream 
sold in Massachusetts is produced in — 
(a) Massachusetts? 
(6) New Hampshire and Vermont? 

(c) Maine? 

(d) Connecticut? 

(e) New York? 
(/) Canada? 



75 

This question was asked in order to ascertain the amount of 
milk obtained in the different States and the Dominion of 
Canada, and particularly the proportion produced outside of 
Massachusetts. Owing to the absence of answers to question 
1, the replies to question 3 cannot be used for this purpose, as 
they are expressed in percentage. 

None of the cream sold by the large dealers doing business 
in greater Boston is produced in Massachusetts. Most of this 
cream comes from Vermont and Maine, and a small supply 
from Canada. Our own investigations, however, show that one 
contractor obtains a large amount of cream from Canada. 
These statements, are therefore by no means conclusive. 

Question 4- — How much of your milk and cream is pasteurized? 
Where is it pasteurized? Type of pasteurizer? 

Maximum temperature of which milk or cream is heated? Time 
held? Temperature of holding? 

Is any of your milk or cream re-pasteurized? If so, state location and 
character of the first and final pasteurizing plant. 

All the large dealers practice pasteurization except in the 
case of the small amounts of certified milk sold and of milk 
sold to milk peddlers. In general, the milk is pasteurized but 
once, at the headquarters of the principal receiving stations of 
the corporations. The holding process is used, the milk being 
held for thirty minutes at a temperature of 143° to 145° F. 
Some of the family cream is repasteurized. In general, a higher 
temperature is used in pasteurizing cream, the dealers stating 
temperatures as high as 165° F. 

Questions 5 and 6. — Do you maintain a system of dairy inspection? 
If so, describe the principal features of your system of dairy inspection. 

To question 5, 7 answered yes and 4 answered no. The 
typical system is to have the agents of the receiving stations 
inspect each dairy three or four times a year, score the same 
and urge the dairymen to correct insanitary conditions. No 
statement is made, however, as to whether or not dairies found 
dirty are excluded. 

One of the largest dealers replying no to question 5, in his 
reply to question 6 showed he maintained an inspection system 
similar to the others, except that he did not score the dairies. 



76 

Several of the large firms have inaugurated features of in- 
spection which deserve special commendation; for example, one 
dealer states they retain a chief inspector who is a thoroughly 
experienced dairyman, a graduate of the New Hampshire State 
Agricultural College, and supplement their inspection by illus- 
trated lectures for the benefit of the producers on the sani- 
tary and economic aspects of milk production. 

Another company retains a veterinary inspector for the ex- 
amination of the cattle and stables, and a bacteriologist of na- 
tional reputation to supervise the bacteriological examinations. 

Another dealer states that his inspector scores the farms using 
the United States dairy score card, and he also employs the 
honor system of inspection. The producer scores his own farm, 
answering monthly a list of four questions by yes or no. These 
questions are relative to cooling the milk below 50° F., having 
and using a milk house, whitewashing the stable, and the win- 
dow and air space per cow. A cash premium is paid if these 
questions are answered in the affirmative. 

Another dealer appears to get into the closest co-operation 
with the local boards of health. He very logically leaves it to 
the board of health to first score and issue a permit to the 
dairy before the milk is purchased. Thereafter they utilize 
their own inspector to see if the dairies keep up the original 
standard set. Whenever they find a decline in these standards 
the board of health is at once notified, thereby placing the 
responsibility for refusing the milk on the local board of 
health, as it should be. 

One corporation makes a practice of having the creamery 
managers accompany the inspectors of the Health Department 
on their visits to the dairies, and your Board is satisfied from 
personal observation that they rigidly refuse to accept the prod- 
uct of any dairy, the score of which is below the requirements 
of the health authorities, until these dairies have complied with 
the recommendations of the inspector. 

At the central plant of this corporation occasional examina- 
tions are made for bacteria and for sediment. If the milk ex- 
hibits any sediment, or if the bacterial content is found to be 
high, the producer is notified of this fact, and the subsequent 
shipments of milk are carefully watched to ascertain whether 



77 

or not the producer has complied with the suggestions made 
by the company. 

One contractor, evidently missing the point of the question, 
rather ingenuously replied, "Yes, by our city inspector and 
also by the State Board of Health." Another contractor 
answered rather modestly, "No," but in all probability main- 
tained a system quite as efficient as his larger competitors. 
He states, "Not a regular system, but I visit them if the milk 
don't suit." 

Somewhat as an offset to the very encouraging and broad- 
minded policies which these contractors maintain and have 
instituted for the purpose of bettering the sanitary quality of 
their product, strict impartiality requires us to state that one 
of the dealers, who now states that he does not repasteurize 
at all, admitted under oath a few years ago that a portion of 
his product was occasionally submitted to a second pasteuri- 
zation. 

The reports of the special investigations made by your Board 
seem to indicate that the system of inspection operated by the 
contractor is not as efficient in certain localities as the con- 
tractor's replies would indicate. In fact, we are forced to con- 
clude that the policy of using the local collecting agent as a 
dairy inspector frequently results in giving the dealers them- 
selves an altogether erroneous impression of the sanitary con- 
ditions pertaining to the dairies from which they obtain their 
milk. 

C. OBSERVATIONS ON PAST AND PRESENT INCREASE, DE- 
CREASE, FLUCTUATIONS AND GEOGRAPHICAL MOVE- 
MENTS OF COMMERCIAL MILK AND CREAM PRODUC- 
TION IN MASSACHUSETTS AND NEIGHBORING STATES 
AND THE PROVINCE OF QUEBEC IN RELATION TO THE 
MILK SUPPLY OF THIS COMMONWEALTH. 

A study of the production of milk in Massachusetts reveals 
the fact that while there has been a constant increase in popu- 
lation in this State since 1885, at which time the statistics 
quoted begin, there has been, at the same time, a decrease in 
the number of milch cows kept in this State. From 1885 to 
1890 there was a great increase in the number of milch cows. 
According to statistics the increase was at the rate of about 



78 

6,400 per year, and in 1890 the highest point was reached in 
the number of cattle, which was 200,658. From 1890 down 
to 1914 there has been a great, although not a uniform, de- 
crease, but in the five years from 1890 to 1895 the decrease 
was almost as great as the increase had been in the previous 
five years. From 1895 to 1897 there was a decrease, although 
not as rapidly as in the previous five years. From 1897 to 
1899 there was an increase in the number of cows kept, which 
in 1899 reached a total of a little more than 180,000. The 
number remained approximately stationary until 1906, and 
from 1906 to the present time there has been a rapid decrease 
at an average rate of 4,000 cows per year. From 1890, when 
the greatest number of milch cows kept in this State was 
reached, until 1914 there has been an average decrease in the 
number of cows of a little over 2,200 per year, so that while 
there was a production of milk at the rate of one-half quart 
per person in Massachusetts in 1890, in 1914 there was pro- 
duced one-fifth quart per person in population. 

Although the amount of milk used per person has increased 
according to different authorities, for the sake of comparison 
we will assume it to be the same. 

Diagrams showing the comparative number of milch cows 
and the population of the State of Massachusetts, also show- 
ing the amount of milk brought into the city of Boston by 
the steam railroads for the years 1896 to 1914, are included 
in this report. The amount of milk and cream is given in mil- 
lions of quarts, and there was a decided decrease from 1906 
to 1911 in the amount handled on trains. From 1911 to 1913 
there was almost as great an increase in the total amount 
handled on the railroads as there had been a decrease in 1906 
to 1911. 

Another interesting diagram shows the relative amount of milk 
handled by the three large railway systems coming to Boston. 
One curve shows the amount of milk handled by the Boston & 
Maine. There was a decrease from 1906 to 1910. From 1910 
to 1911 the amount remained about the same, but from 1911 
to 1913 there was a very rapid increase in the amount handled 
by this railroad, which increase corresponds to the rapid in- 
crease in the total amount of milk brought into Boston. 



79 



On the New York, New Haven & Hartford Railroad there 
was an increase in the amount brought into Boston from the 







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remained about constant from 1912 to 1914. 

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decrease from the year 1906 to the year 1914. The increase in 



80 

the amount of milk brought into Boston by the Boston & 
Maine Railroad from 1911 to 1913 corresponds with the in- 
crease in the total amount of milk brought into Boston for 
those years. In 1913 to 1914 there is a decrease shown in the 
amount which also corresponds to the decrease in the total 
amount. The increase in the amount brought into Boston by 
the Boston & Maine not only corresponds to the increase in 
the total amount brought into Boston, but it also corresponds 
with the amount of milk brought into Massachusetts from the 
Province of Quebec by different Boston contractors. 

It would seem from the diagram that the milk contractors 
have been going farther from Massachusetts, as time goes on, 
to get the milk and cream with which they are supplying the 
people of this State. 

A feature of the diagram is the notable decrease in the total 
amount of milk and cream coming into Boston in the years 
1913 and 1914, whereas the increase in the population of Bos- 
ton, or the metropolitan district, which probably receives most 
of the milk and cream which is brought into Boston by the 
railroads, has been at about the same rate as in previous years. 
This discrepancy has been studied with a view to finding out 
whether there has been a per capita decrease in the amount of 
milk and cream used as stated by several parties, but it has 
not been found that this is so. Neither has it been determined 
that people are using more milk and cream per capita than 
formerly, as has also been stated, but the amount probably 
remains about the same. A part of the decrease can be ac- 
counted for by the statements of some of the milk contractors 
that the surplus which formerly was shipped into Boston and 
manufactured into butter and other products at the Boston 
milk stations is now largely cared for out in the country, thus 
relieving the factories of some of the work, and resulting in a 
saving in railroad transportation. Probably the increased use 
of condensed, evaporated and powdered milk accounts for some 
of the decrease in the amount brought in by the railroads, as 
shown by the figures obtained from the Chamber of Commerce 
and agents of two of the large condensing and evaporating 
firms. 

A study has been made to find out to what extent condensed, 
evaporated and powdered milk has taken the place of fluid milk 



81 



in manufacturing and in the homes, and these results are in- 
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cost standpoint, should receive a great deal of attention, and, 
in fact, there has been a great deal of time, with attendant 
expense, devoted to this side of the question in milk produc- 
tion. There must have been good reasons for the study of the 
production costs when the question was a new one, but it seems 



82 

unnecessary to continue such work to any great extent, in view 
of the fact that all sides of the question have been thoroughly 
considered and the results have invariably been the same, and 
so far as can be ascertained no dispute as to the statements of 
cost has been made. Taking into consideration the fact that 
only a small percentage of the milk producers have kept item- 
ized accounts that would enable them to accurately determine 
the cost of producing a quart of milk, and also the fact that 
conditions vary so on different farms even in the same locality, 
the question is raised as to the value of any one set of figures 
being greater than another. That the figures given by different 
producers who have testified at different investigations, and 
who have given this Board figures on the cost of producing, do 
not agree is no reason for condemning such figures, as the con- 
ditions vary so much on the different farms on account of the 
varied lines of agriculture carried on at these places that they 
may be just as accurate and reliable in one case as in another, 
and it would seem to be impossible to fix any exact price for 
which milk could be produced as long as it is produced under 
the many different conditions as at present. But as the cost 
estimates vary so slightly, that is, generally within less than 
a cent per quart, it would seem as though an approximate idea 
can be obtained of the cost in the different zones. 

In some cases milch cows are kept as the sole source of in- 
come, and one will naturally think that in that case the lowest 
cost of production would be reached, but such is not always 
the fact, as in some of the cases the highest cost of production 
is reached. It is difficult to form an opinion as to the exact 
cost of production on those farms where the dairy business is 
run simply as a side line, as a part of the profits on these places 
is the fertilizer that is used in producing the vegetables or 
fruit, and it has been said that the value of the fertilizer varies 
with the value of the crop raised, so that some people have 
maintained that it was difficult to estimate the value of a cord 
of manure, as in some soils the value will be much greater than 
others. Stable manures have a much greater value than a com- 
mercial fertilizer containing the same amount of nutritive ele- 
ments when used in a soil that needs the addition of humus. . 

It must be a fact that the cost of producing a quart of 
milk has increased in the last few years, as all of the material 



83 

used in the construction of buildings and the feeding of cattle 
has decidedly increased. The price of cows has greatly in- 
creased, and also the price of all farm labor. It has been 
stated by some of the milk producers with whom we have cor- 
responded that the cost of producing a quart of milk has in- 
creased 15 per cent, in the last few years, and it is safe to say 
that the increased cost of producing a quart of milk is greater 
near the large centers of population than in the more remote 
districts, owing to the fact that labor costs generally more, and 
that taxes on farm lands have been increased more in propor- 
tion than they have in the outlying districts. 

The element of pastures enters largely into the cost of the 
production of milk, because milk can be produced more cheaply 
in the sections where the pastures are good than in the sections 
where the pastures are poor. The dairying sections of the 
states of Vermont and New Hampshire can produce milk more' 
cheaply for this reason than many sections of Massachusetts, 
and in proportion milk can be produced more cheaply in the 
Province of Quebec than in the portions of Vermont and New 
Hampshire mentioned. This is due to the fact that the farther 
north one goes from the city of Boston to the St. Lawrence 
River in Canada the heavier soils produce more and better 
pastures than the sandy soil in the eastern part of Massa- 
chusetts, and also to the fact that good pasture lands are 
much cheaper in Canada than in the New England States. 

It is a mistake to say that because farmers do not keep an 
accurate set of books they do not know whether there is a 
profit or loss in the production of milk. In interviewing a large 
number it has been found that those who have been milk 
producers for more than four or five years have a very good 
idea of the cost of milk production which experience has given 
them. Almost any farmer of a few years' experience knows 
how much hay or other forage his place produces; knows in a 
general way how much money he is spending every month for 
grain; can easily tell whether his farm has increased in pro- 
duction; and, if he is dependent entirely oil the dairy business, 
most certainly knows whether he has more money or less than 
formerly. 

To give an idea of the importance of the dairy industry in 
the United States, statistics from the United States Census 



84 

reports are used as being the only ones available and with the 
belief that these figures are approximately correct; but it 
must be understood that these figures do not show anything 
as to the great importance of dairying in its connection with 
other lines of agriculture, which may well be said to rely upon 
the keeping of cattle for their perpetuation, and it is probable 
that many agricultural products would greatly advance in 
price owing to the difficulty of producing them without the 
animal fertilizers produced in dairying. It has been stated by 
competent judges of agricultural work that the only way in 
which milk production can be carried on successfully in New 
England is in combination with other lines of agriculture, and 
in the future we must depend upon the farmer who produces 
milk as one line of his diversified farming rather than on the 
men who will keep large herds of milch cows and follow milk 
production as an exclusive line. 

Milk production by small farmers as a side line would 
probably be much better for the consumer from a cost point of 
view, as it is extremely doubtful if a combination to raise or 
fix prices could ever be effected, and in connection with this 
statement it might be well to call attention to the statements 
of interested persons who have said that if it had been the 
custom of New England milk producers to conduct the business 
as an exclusive line rather than a side line the public long ago 
would have been compelled to pay a much larger price for 
dairy products. It is only because the other lines have been 
more profitable than dairying that the farmers have been able 
to produce milk and sell it at less than the actual cost. 

Uses of Milk. 
Cow's milk and its manufactured products have many uses, 
and there will always be a demand for this important article. 
Probably the most important use to which milk is put is the 
feeding of infants, and it seems improbable that we could ever 
find a substitute for milk for this purpose that would be as 
satisfactory or as efficient. Milk occupies an important place 
in the daily diet of many people who either have to use it as a 
portion of their food, or in some cases as their entire food on 
account of physical disorders, or who find it an agreeable and 



85 



nutritious article of diet to be used daily in conjunction with 
the more solid foods. 

The use of cream has increased very fast in the last twenty 
years, and is considered by many as an indispensable article 



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in the daily menu. The ice-cream business has assumed vast 
proportions, and the use of cream in the manufacture of ice 
cream is an important factor. Milk is used more extensively 
than ever before for cooking purposes, and bakers nowadays 



86 



make more products containing milk than formerly. Butter is 
too well known a commodity to require any comment, but 
attention should be drawn to the fact that buttermilk has a 
considerable market value at the present time, and its use as 



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a beverage has become quite a factor in disposing of the 
by-product of butter-making which formerly had little value. 
Cheese is a highly important product of the dairy industry, and 
its use is said to be increasing. The amount of butter and 



87 



cheese produced in Massachusetts is very small, and is generally 
produced for home* use only. - 

By-products of milk aroused in the manufacture of difterent 
articles to an extent that is almost incomprehensible to the 
uninformed. In considering the many ways in which milk is 
used it is well to follow it from its point of production through 
the many hands and operations before it reaches the consumer. 
In New England, as a general thing, the whole milk is sold by 
the producers to large dealers who run cars out into the pro- 
ducing districts, and who either receive it at the car or at the 
local receiving station, where it may be separated and the 
cream shipped to the large centers and the skimmed milk used 
in various ways, or the whole milk may be shipped without 
any treatment except icing in a more or less efficient way. lhe 
whole milk or the cream may or may not be pasteurized at the 
receiving station or country creamery. The country shipping 
point may be 300 or more miles away from the mam plant. 
If the receiving station is a creamery where butter is manufac- 
tured the farmers generally bring in the whole milk, although 
in some cases they have separators and carry m only the cream 
The farmers who bring in whole milk buy back the skimmed 
milk The skimmed milk is used for feeding calves, hogs and 
poultry. It has been said that in former years some creameries 
followed the custom of either giving the skimmed milk away or 
throwing it on to the ground or into streams where it would 
flow away. In some parts of the country serious stream pollu- 
tion has been reported in many cases where the latter method 
has been adopted, but it may be that the pollution was more 
the result of materials used in washing utensils and floors than 
of the skimmed milk. Of late years, where there has been a 
large amount of skimmed milk at the milk stations, it has be- 
come the custom to reduce the skimmed milk to milk powder 
for bakers' use, or for use in some instances in making a so- 
called synthetic milk by the addition of fat and water in proper 
proportions. In some instances it is made into a high protein 
" feed for poultry, and to some extent is used in the manu- 
facture of cold-water paint. Quite a considerable quantity -ol 
skimmed milk is condensed for use on board ships, etc. When 
skimmed milk is spoiled by age or in some other way, or where 



88 

there is no other method of disposing of it, the most common 
procedure is to manufacture casein. 

Casein is used very extensively in the paper industry, making 
possible the manufacture of washable wall papers, also in the 
waterproofing of paper flasks, cartons and wrapping papers. 
It is used for coating paper slates and drawing papers, and as 
a fixing agent for enamels and colors on papers. Casein paints 
are quite extensively used, and the plasters which can be made 
by the combination of casein with other substances are useful 
in the decorator's art and for making molds. Insulators for elec- 
trical appliances and transparent sheets resembling celluloid and 
mica are manufactured from casein compounds, and in the dye- 
ing and printing of textile fabrics it is also very useful. Casein 
is used in large quantities in the manufacture of linoleums, 
and, to some extent, in the compounding of medicines and 
foods. 

When we consider how important milk has become as an 
article of food and in the arts and sciences, and how useful even 
the poorer parts and cheaper grades can be, it would seem as 
though the encouragement of the production of milk must 
surely tend to increase the general prosperity of the entire 
country. When we consider the enormous amount of money 
involved in the dairy industry of the United States, and the 
important uses to which dairy products are adapted, we are 
justified in pausing for a while before declaring that certain 
laws and regulations would be either beneficial or detrimental 
to this great industry. 

Many reasons have been assigned or suggested as having 
had a direct influence on the decrease in the amount of milk 
produced in the State of Massachusetts. These are quoted not 
as matters of fact, but simply to record some of the ideas as 
expressed by various persons. Several persons have suggested 
that the past work of the State Board of Health has had a 
decided influence by reason of the methods employed in prose- 
cuting farmers and others for offences against the law. 1 

Another reason for the decrease in production is said to be 

1 The critics did not take into account the fact that the State Board of Health had for years 
practiced the warning system with no advantage, and the new secretary furnished the inspectors 
a long list of the people who had been warned. The samples collected resulted in a large number 
of prosecutions. — H. C. L. 



89 

the result of milk-borne epidemics being sensationally featured 
by the newspapers. This publicity is said to have resulted in 
a decrease in the amount of milk- consumed for at least a time. 
Many producers have stated that a large part of the decrease 
has been due to the feeling of unrest and insecurity on the 
part of the farmers, occasioned by the constant agitation, legis- 
lative and otherwise, that they have been subjected to for the 
past several years, and some have said that improvements have 
been delayed in many cases because dairymen were afraid that 
it would not pay them to stay in the business if drastic laws 
were to be passed. 

Another reason is said to be the constantly increasing use of 
condensed and evaporated milk by families and the increase in 
the amount of milk powders used by bakers. Probably the 
increased use of milk powders and of condensed and evaporated 
milk is responsible for some of the decrease in the amount of 
milk brought into Boston by the different railroads in the year 
1913, and also for the general decrease of about 10,000,000 
gallons in the yearly amount between the years 1906 and 1914. 

How much bearing the financial panics and bad business 
conditions of -different periods may have had on the amount 
of milk produced and the amount consumed is problematical, 
but we may well assume that such conditions have had their 
influence. 

A large number of dairymen have given the low price paid to 
the producer as the principal and almost only reason for the 
great decrease in production in this State. This seems to be 
the most reasonable one, because many of the producers have 
said that the price received for milk during the last few years 
has not been sufficient to enable them to make a profit, and 
that in many cases the price paid was below the cost of pro- 
duction. 

It has been stated by many dairymen that the production 
per cow in Massachusetts has increased from 10 to 15 per cent, 
in the last fifteen years, this increase having been secured by 
more careful selection of cattle, breeding for production, and 
because of a better knowledge of the problems of feeding. 
Some have claimed that the greater production of the Mas- 
sachusetts herds over those of other States and countries 



90 

should have helped the dairymen in overcoming the difference 
of cost in production between this State and States farther 
north, where the pasture conditions are better than they 
generally are in Massachusetts. 

Criticisms have been made of the result of the Saunders law, 
which at one time was believed would help Massachusetts 
producers, but many have expressed the opinion that it has 
really resulted in hurting the Massachusetts industry. 

Another reason assigned as the cause of decrease in pro- 
duction in the State of Massachusetts is the growing interest 
taken in fruit, vegetable and poultry raising by farmers who 
were formerly engaged in dairying. 

Scarcity of labor at reasonable prices has also been given as 
one of the reasons for the decline, and some farmers claim to 
have been discouraged by the fact that the only laborer avail- 
able at any price in some districts is the foreign-born laborer, 
who does not understand the English language, and who 
understands but little of farming conditions and work in this 
country; and it is a fact that new arrivals on these shores 
demand, in many cases, $30 to $35 per month and board, and 
generally obtain these prices on account of the scarcity of 
laborers. 

An interesting feature of the business of milk production in 
Massachusetts at the present time is the work being done by 
the State Board of Agriculture, through its Dairy Bureau, 
along the lines of the encouragement of a greater production of 
milk of a high quality. For the purpose of interesting Massa- 
chusetts dairymen the Legislature has appropriated money to 
the State Board of Agriculture, and they have conducted for 
the last three years a series of clean milk contests, which has 
resulted in the production of high-class milk on places which 
formerly had been somewhat indifferent to some of the neces- 
sary details of clean milk production. 

The Milk Board in conducting its dairy investigations has 
visited several places that have been entered in these clean 
milk contests, some of which have won prizes. The winning of 
a prize in these contests has meant a great deal to the winners, 
as it has resulted, in some instances, in then* getting a better 
price for milk when they distributed their milk direct to the 
consumer. 



60 
60 

75 
30 
1 60 
40 
60 



91 

There are some good figures available on cost of production 
of milk in Massachusetts, probably none of them better than 
those of Elmer D. Howe of Marlborough, a practical dairyman, 
who is a graduate and trustee of the Massachusetts Agricultural 
College, and also a past master of the Massachusetts State 
Grange. The figures are based on his own herd of 40 cows. 
Mr. Howe says: — 

Our experiment stations agree that the average cow in milk needs, 
for economical production, 25 pounds of hay or its equivalent in silage, 
roots, etc., plus 8 pounds of grain. This will make the food cost per day 
(with hay at $20 per ton and grain at $30 per ton) 37 cents per cow. 

For 40 cows, food cost per day equals $14 80 

A building for housing stock and hay will average to cost $100 per cow 

interest on $4,000 at 5 per cent, equals per day, 
Depreciation of building at 5 per cent, per year equals per day, 
Depreciation of cows and loss in replacing equals per day (low esti 

mate), . . • • • • • 

Taxes on building and cows (not on land) per day, 
Milking 40 cows at 20 cents per hour equals per day, 
Grooming 40 cows equals per day, 
Cleaning stables and feeding per day, . 
Wear and tear of small tools, currycombs, brooms, etc., including service 

of bull, cost of city water, veterinary fees, ice, light, etc 15 

$19 80 
Against this we have a credit of $2.50 per day for manure and 30 cents 

per day for calves born during the year (calves at $3 each at birth), . 2 80 

Net cost for 40 cows per day, . . . ' • • •, . $17 00 

For more than fifteen years we have weighed every cow's milk both 
morning and night, and our records show that our cows (and we keep 
none that give less than 5,000 pounds per year) average just about 7 
quarts per day. Forty cows, then, will average to produce 280 quarts 
of milk per day at an average daily cost of $17, or a trifle over 6 cents 
per quart. 

By substituting 30 pounds of ensilage for 15 pounds of hay in the 
daily ration of each cow we are able to cut the cost to about 5 cents per 
quart, but the closest scrutiny will not reveal any other item where a 
saving can be made. 

That Mr. Howe's figures are not too high is obvious when 
we consider that he has made no account of waste in handling, 
superintendence or profits beyond interest at 5 per cent. 

Prof. John M. Trueman, formerly of the Connecticut Agri- 
cultural College, Storrs, Conn., says: — 



92 



Cost of Feeding. 1 



Silage, 4 tons at $4, . 
Hay, lj tons at $16, . 
Grain, 1J tons at $30, 
Pasture, four months, 



$16 


00 


24 


00 


37 50 


8 


00 



Total, 



$85 50 



In years when pasture is short, and grain and silage or green fodder 
must be fed all summer, the cost per year will frequently go up as high 
as $100. 

The total cost of keeping each cow per year, therefore, is as follows : — 



Feed, 

Bedding, ..... 

Keep of bull (for herd of 25 cows) , 

Taxes on cow and barn, 

Interest on money invested in cows, 

Barn rent, .... 

Insurance, .... 

Depreciation of cow, . 

Light, medicine, etc., 

Labor, ..... 

Total, . - . 



$85 00 



5 


00 


3 


00 


1 


25 


3 


75 


3 00 




40 


13 


00 


2 


00 


33 


60 



$150 00 



The cows thus fed and cared for included Jerseys, Guernseys, Ayr- 
shires and Holsteins. Some were very good producers, others only fair. 
The average for the whole lot for the five years was 6,378 pounds per 
cow, which, on the basis of 2J pounds to the quart, is equal to 2,834 
quarts. Although this is not a heavy yield, it is a good average for a 
herd of 25 cows made up of several breeds. It requires extra skill and 
good management to increase the yield beyond this point. When it is 
remembered that the average yearly production for the New England 
States is less than 2,200 quarts per cow, it will seem that a herd making 
over 2,834 is doing fairly well. It is useless, therefore, to hope to de- 
crease the cost of milk by much further increase in the yearly production 
of the cows. Any material increase over 3,000 quarts in a large herd 
comes high from the necessary weeding out of ordinary producers and 
the small numbers of high producers to be found. 

The cow should be credited with her calves and with the manure she 
makes. We cannot allow more than $5 per year for calves, nor more 
than $10 per year for manure in the barnyard. We can, therefore, credit 
the cow with $15 and subtract that amount from the $150 that it cost 
to keep her. This leaves $135 to be balanced by 2,834 quarts of milk, 
which would require the milk to be sold at the farmer's door for practically 
4.75 cents per quart. This amount simply pays for the actual cost of 



1 These figures represent the average cost of five years, 1907-11, and are somewhat too low for 
1913. 



93 



the investment and labor put on the milk. It allows nothing for the 
farmer's skill as manager, nor for the extra hours he must work planning 
for the improvement of his herd and the running of the business, and 
nothing for the profits. He has simply received 5 per cent, on his in- 
vestment and common laborer's wages. 

If he is going to improve his farm and build up a permanent agriculture 
in an advancing rural community, and continue in business, he will 
require 5.75 cents or more per quart to pay the bill. 

Fred Rasmussen, professor of dairying, New Hampshire 
Agricultural College, Durham, N. H., says: — 

The last census report shows the average production of milk per cow 
in Massachusetts to be 4,524 pounds, in New Hampshire 3,775 pounds, 
in Vermont 3,982 pounds. No doubt the actual production in the several 
States is higher than this. In the writer's opinion a more nearly correct 
estimate is between 5,000 and 5,500 pounds of milk. 

To get conditions which will represent average production for Mas- 
sachusetts, New Hampshire and Vermont let us take the 39 cows, of 
the 26 herds 1 studied, producing between 5,500 and 6,000 pounds with 
an average production of 5,540 pounds of milk. 



The Cost of Production. 
Cost of feed, 2 
Labor, , . 
Delivery, . 
Housing, . 
Depreciation, 
Bedding, . 
Bull, 

Taxes and interest, 
Ice, coal and wood for heating, 
Veterinary service and medicine, 
Tools, utensils, salt, etc., 



Credit: — 
Manure, . 
Calf, 



$66 91 

32 33 

6 16 

9 05 

8 83 



$139 19 



$15 00 
3 00 



18 00 



Total, 



$121 19 



1 See Circular No. 8 of this series; also Bulletin No. 2, New Hampshire College and Experiment 
Station. 

2 It costs less to feed these "average" cows than it does higher producers, which accounts for 
the difference in figures here given from those used in Circular No. 8. 



94 



Comparison of Increase in Cost of Production with Increase in 
Price obtained by Farmer. 

The following table gives comparison of cost of feeds and 
prices received for milk, 1904 to 1912. The prices are those of 
the Boston Chamber of Commerce, and records compiled by 
J. B. Lindsey. The price of milk per quart to the farmer is the 
price paid in the middle zone by one of the largest milk con- 
tractors in Boston. The price paid by the consumer for milk 
is the price paid for milk delivered in glass bottles for family 
use in Boston. 



95 






ft Q, 



1^° 



OSH 



c o 
ffl 



.SOfe 
Q a 






2 o 



96 

Professor Lindsey gives the following figures on the cost of 
production of 131 cows from 1896 to 1911: — 

Average yearly food cost per cow, . . $89 24 

Net yearly fixed charges per cow (estimated), . . . . $56 00 

Total cost per cow, $145 24 

Average yearly yield per cow (pounds), 6,036.3 

Average yearly yield per cow (quarts), 2,683 

Cost of milk (100 pounds), . . . . . • . . . $2 41 

Cost of milk (1 quart) (cents), 5.43 

Financing the Cow. 

Few people have any idea what it costs to finance the cow. 
We know of no New England data upon the subject. The New 
York Experiment Station at Geneva has made a study of this 
question as applied to the milk supply of that city, and Bulle- 
tin No. 563 says: — 

Considered from the agricultural standpoint, the capitalization amounts 
to $763 per cow, of which the producer furnished $680 and the retailer 



In other words, it costs the milk producers supplying milk 
to Geneva, N. Y., a city of about 13,000 inhabitants, $680 to 
finance each cow, and it costs the distributors $83 to finance 
the distribution of the milk of each cow. 

The capital invested was estimated as follows : — 

600 cows at $80, $48,000 

3,000 acres of land with buildings, 300,000 

Equipment, $20 per acre, 60,000 

$408,000 
Capital invested in distribution, 50,000 

Total, . . . . . $458,000 

That the Massachusetts dairyman is progressive is evidenced 
by figures of milk production in Massachusetts as compared 
with the States of Vermont and New Hampshire. 

Professor Rasmussen says that the average annual produc- 
tion per cow in those States is as follows: — 

Pounds . 

Massachusetts, 4,524 

Vermont, 3,982 

New Hampshire, . . . 3,775 



97 

Assuming that a quart of standard milk weighs 2.15 pounds, 
the production in quarts per day would be — 

Quarts. 

Massachusetts, 5f 

Vermont, 5 

New Hampshire, 4.8 

These figures are interesting in view of the fact that Ver- 
mont has generally been considered the dairy State of New 
England. 

An interesting feature is the belief of admirers of different 
thoroughbred varieties of cattle that the breed which they ad- 
mire is the best for certain purposes, which ideas are not always 
substantiated by facts. Too much emphasis is laid on individ- 
ual work and not enough on herd work; as, for instance, in 
the Holstein breed the herd records, so far as we have them, 
are in no way comparable with individual records, and it is 
a mistake to think that thoroughbred herds exceed in produc- 
tion, to any great extent, the good herds of grade cows; at 
least, the observation of the committee has shown it thus. 

That there are fads and fashions in all things is just as true 
of the dairy business as of other things, and many a dairyman 
owes a part of his failure in dairying to the fact that he has 
been caught by a fad. 

Fads in feediag cattle have followed a knowledge acquired 
after patient study and research by competent persons, by 
parties who have absorbed only a part of the idea and have 
had the benefit of other conditions to help them out for a 
while; but when the favorable elements have been removed 
they found that the profits have been wiped out by wasteful 
and injudicious feeding methods, also by dairymen following 
ration formulae used by gentlemen farmers and others in trials 
for advance registry records. Such fads and heavy feeding 
methods have resulted in very many cases of udder troubles 
that seriously affect the quality of the milk from such cows, 
both from a health standpoint and also a commercial point of 
view, as well as being a deteriorating factor in the value of 
ttie cow. 

If there has been a profit in milk production in Massachu- 
setts in the last few years among those dairymen who sell 
their product to the large dealers, it has been among those 



98 

who raise the largest proportion of the stock feed on their own 
place. This class of producers, that is, the ones who raise most 
of the fodder and a good part of the grain used in feeding their 
herds, do not as a general thing produce as much milk or cream 
as those who buy and feed generously the high concentrates 
now common in the markets; but they do keep a larger part 
of the gross receipts in their own pockets, and the cattle fed 
in the old-fashioned way are almost invariably healthier and 
remain producers longer than the highly pampered and fed 
cattle. Cases of milk fever, garget and other udder troubles, 
and also tuberculosis, are less prevalent in herds that have not 
been crowded. 

The old-fashioned way spoken of is the one followed by many 
Worcester County farmers formerly, and by a less number now, 
and the ration is generally composed of hay, clover and cut 
dry corn stalks for roughage, turnips and mangles for succulent 
feed, and the field corn ground into what is called cob grist, — 
that is, the whole ear is ground and fed as meal with some of 
the wheat feeds, such as bran or mixed feed, — and by this 
method of feeding, which gives a good nutritive ratio, the high- 
est natural production can be obtained. Any crowding with 
concentrates is unnatural, and requires the best efforts of an 
expert cattle feeder to keep the herd in good shape. 

Large and Small Herds. 

The cost of maintaining a large herd, of cattle is less in pro- 
portion in some ways and not in others, for while any large 
business is done on a more economical basis than a small one 
when materials are bought, still, the smaller dairies that are 
run in conjunction with general farming are sometimes more 
profitable in proportion, as they provide something for the 
farmers to do in the winter time when other lines of his busi- 
ness are at a standstill. 

Condensed and Evaporated Milk and Milk Powders. 

An Interview with Mr. W. J. Reid, Local Manager for 

the Van Camp Company. 

Mr. Reid says that the Van Camp Company's business in 

evaporated milk increased at least 100 per cent., perhaps 125 

per cent., from 1906 to 1914, and that the business was very 



99 

profitable from 1906 to 1912. Since 1912 there has been no 
profit in the evaporated milk business, owing to the increased 
cost of everything used in the manufacture and shipping and 
to the, scarcity of milk. The Van Camp evaporating plants 
have been running half time recently, owing to the scarcity, 
and in 1910 a large plant that the company was running at 
St. Albans, Vt., was discontinued, as not enough milk could be 
obtained to make it profitable. Mr. Reid says that the cases 
in which the evaporated milk is packed now cost 18 cents 
apiece where formerly they were bought for 5 cents apiece. 
The cans used in putting up the milk cost at least 40 per cent, 
more than a few years ago. The labels also have increased in 
price, and there has been a considerable increase in the price 
paid for labor, but in spite of these increased costs the price of 
evaporated milk per case, for the year 1915 averaged $3 a 
case, against a price of $3.55 per case in 1912. Mr. Reid made 
the statement that his firm believed that there was no profit 
in the evaporated milk business at the present time (1915), nor 
would there be any until the consumers were willing to pay more 
than they do. Keen competition among the manufacturers of 
evaporated milk made it impossible to do anything in a general 
way toward advancing prices. Mr. Reid said that the evapo- 
rated milk business was the only one of their many lines where 
the manufactured product did not respond to the market price 
of the raw material, and said that all other lines that they 
handle were advanced or lowered in price to correspond with 
market conditions. For instance, their best brand of baked 
beans is now selling for 20 cents per can instead of 14 cents as 
formerly, and this is due to the advanced price of the raw bean. 

Interview with Mr. George Wm. Bentley, Agent for 
the Borden Condensed Milk Company. 
Mr. Bentley says that at the present time the condensed milk 
business is not in a very satisfactory condition; that it is im- 
possible for him to get enough condensed milk from the 
factories to fill their regular orders; that the reason for this is 
the scarcity of the raw product; and that so scarce is the fluid 
milk for manufacturing into condensed milk that their com- 
pany is now going into Canada for more milk and to open 
manufactories. He also says that until within two years the 



100 



condensed milk business had increased at the rate of about 
15 per cent, per year since 1906, but that it was now falling 
off almost as fast as it had increased up to 1912. Part of this 
decrease is due to the fact that there is a less demand, and 
part to the above-mentioned shortage of the raw milk. Mr. 
Bentley said that the less demand by the public might be due 
to the financial conditions of the past few years, but did not 
see why there should have been any idea that this was economy, 
as he considered that the public was getting more for their 
money when they bought milk or any of its products than in 
any other line of food. Mr. Bentley very kindly offered to give 
the Milk Board figures to show the amount of condensed milk 
his firm had handled for several years back. These figures 
have not yet been acquired by the Milk Board. 

Interview with Mr. Louis W. de Pass, in Charge of 
Statistics at the Boston Chamber of Commerce. 

Mr. De Pass gave the figures on the amount of condensed, 
evaporated and powdered milk coming into Boston for the 
years 1912, 1913 and 1914, with the amount from Jan. 1 to 
Nov. 1, 1915. Mr. De Pass only began to keep these figures 
in the year beginning 1912. The amounts are as follows: — 



Cases. 



Barrels. 



1912, . 

1913, . 

1914, . 

Jan. 1 to Nov. 1, 1915, 
Jan. 1 to Nov. 1, 1914, 
November, 1914, . 
December, 1914, . 



321,946 


2,304 


321,883 


3,484 


432,601 


851 


326,474 


5,145 


355,932 


606 


34,253 


40 


42,416 


205 



In the opinion of Mr. De Pass there has been a decided 
increase in the amount of condensed and evaporated milk 
handled for the last few years, and he did not think that the 
financial conditions of the last few years had caused any 
decrease in the amount of this product coming into the city of 
Boston. 



101 

The figures quoted are made up from the dairy returns of all 
the railroads running into Boston, and are said to be accurate, 
but there has been no attempt made to separate the different 
kinds of milk preparations. 

Comments on Milk Production. 

Although considerable time has been spent in the investi- 
gation of the different factors entering into the business of milk 
production, it is by no means certain that enough information 
has been gathered from which to draw conclusions as to the 
exact condition of milk production in Massachusetts, and it 
would be unwise to make any efforts toward the regulations of 
the dairy business from a health or any other standpoint until 
the findings of this investigation have been carefully reviewed, 
as there is a possibility that the dairy business in Massachusetts 
is in danger of becoming almost entirely eliminated unless 
something is done to restore confidence. 

A study of the census reports shows that in all of the New 
England States, except Rhode Island, there has been a great 
decrease in the number of milch cows kept, this decrease being 
most pronounced since 1890; that the consuming public of 
Massachusetts has been obliged to use milk from dairies far 
beyond the points where the milk supply was formerly ob- 
tained; and that the distance has steadily increased and nearby 
production has steadily decreased, so that it would appear 
as though the future generations would have but a small 
amount, if any, of milk from near-by points. 

If milk is an important article of food, and if the quality is 
at all an important feature, it is evident that it becomes neces- 
sary that the near-by production of milk should receive such 
encouragement as can be given. Although the milk business 
owes its. principal decline to strictly commercial causes, it must 
be revived for more important reasons than that of commercial 
interest, and one of the most important and vital reasons is 
the preservation of the life and health of our people. 

That milk is a necessary article of diet is admitted by all, 
and its importance in the diet of infants and invalids is incal- 
culable, because on the use of cow's milk depends the lives of 
many, who, from unavoidable causes, are compelled to rely on 



102 

it for varying periods of time. It is said by several authorities 
that breast feeding of infants is on the decline in this country, 
and if that is a fact, then we must depend more and more on 
the cow to provide sustenance for those who unfortunately are 
denied their natural food. 

If the statistics in regard to milk production gathered during 
this investigation are correct, and we believe them to be so, 
then we must be approaching at a greater, or less rate of speed 
the time when a good quality of cow's milk for our infants' 
nourishment will become a rare and consequently high-priced 
article. It therefore seems as though the complaints of the 
future would be numerous in regard to the milk situation, but 
along distinctly different lines than at present. If the produc- 
tion of milk within a reasonable distance of the city of Boston 
shall decrease as fast in the next twenty-five years as it has 
in the past twenty-five years, and the farmers in zones that are 
now supplying a large part of the milk which was formerly 
produced nearer Boston become convinced of the fact that milk 
production is a financial failure under prevailing conditions (and 
personal interviews with many producers of those zones have 
shown us that the more thoughtful ones believe this to be the 
case), it is only a question of time when we will have no ade- 
quate locally produced milk supply suitable for infants, invalids 
or those who need it as an article of daily diet. 

It has been suggested by some farmers that the best way to 
remedy the financial conditions under which producers labor 
at the present time, and have for some time in the past, is for 
the dairymen to cease the production of milk and go into other 
and more remunerative lines of agriculture, with the expecta- 
tion that a shortage in the supply of milk would bring an ad- 
vance in prices that would make the production of milk a pay- 
ing line of agriculture. This idea, however, is probably an 
erroneous one, for it is well known that those dairymen who 
have given up milk production and have engaged in vegetable, 
fruit or poultry raising, or other agricultural lines, have seldom 
returned to dairying because it is much more exacting in regard 
to hours and close application throughout a whole year than 
is the production of seasonable crops or poultry husbandry; 
and also because a return to the dairy industry means either 



103 

a large outlay of money at the start or a slow process of build- 
ing up a herd with which to do business. 

An important reason why the dairy business should be en- 
couraged is that all other lines of agriculture depend largely 
on the animal fertilizers for best results in growing farm crops, 
and except in a small percentage of cases farms certainly do 
run down and become less productive where the animal fer- 
tilizers are lacking. 

It is a fact that some farms have been successfully run on 
commercial fertilizers and green manures, but it does not seem 
probable that the method will ever become general, as it re- 
quires more than the ordinary amount of scientific knowledge 
of chemistry, etc., than we can expect to find among our com- 
mon farmers. 

Agriculture along the lines now common in our New England 
States must be fostered if we are to continue to have a supply 
of the native-grown fruits and vegetables that we are accus- 
tomed to, and no one should dispute the statement that New 
England quality in all lines of fruits and vegetables native to 
these States is high. 

The working classes are the ones who must bear the burden 
of the high cost of living, and to them any advance in price of 
any necessary article of food is of great importance, and it is 
very necessary that in the study of conditions relating to the 
production of milk due consideration should be given this part 
of the subject. 

The lack of uniformity in the price paid to producers of milk 
whose output comes into the Massachusetts market is appar- 
ent, and the Milk Board has found in their investigation that 
the amount paid per 8|-quart can varies from 25 to 56 cents 
per can in different sections of New England, but as only a 
small part of the total is sold for the latter price it is very dif- 
ficult to say what the average price may be. The estimated 
average price paid is 31 cents per 8|-quart can, and the esti- 
mated average price to the consumers is 9 cents per quart, or 
about 75 cents per 8^-quart can. Our investigation has shown 
that the retail price of milk of the ordinary market quality 
varies from 6 cents per quart in the town of Great Barring- 
ton to 12 cents per quart in the towns on Cape Cod, where 



104 



the greater part of the milk is produced in the summer season 
to be sold to summer residents. Certified milk seems to be 
a small part of the total amount, probably less than 1 per 
cent., and the prices are said to vary from 12 to 20 cents per 
quart, although a small amount is sold at a higher price. It 
has been ascertained that producers in the State of Maine are 
paid a much better price for milk by a large concern doing the 
principal business in that section than are producers in other 
sections equally distant from Boston who deal with other com- 
panies. There is also a lack of uniformity in deducting the 
transportation charges from what is called the Boston price, 
which transportation charges vary in the different zones. 

It is said that in some instances milk is transported by rail- 
road twice as far for a given price as it is in others, which, of 
course, must increase the unfavorable conditions surrounding 
the milk industry. 

The management of the Boston & Maine Railroad has re- 
cently petitioned the Massachusetts Public Service Commission 
for permission to increase rates for hauling milk, but nothing 
has been done along this line, as it has been claimed by some 
of the interested parties that it is an interstate question, and 
must be settled by the United States Interstate Commerce 
Commission. 

In one of the Boston Sunday papers of Jan. 9, 1916, a state- 
ment was made that the Interstate Commerce Commission is 
to make an investigation of milk transportation rates in the 
New England States. 

Any increase in transportation rates at this time must mean 
an increased price to the consumer, as the producers cannot 
stand a smaller price than they are now receiving, and the 
dealers have stated that they cannot do business on a smaller 
margin of profit than that which they now receive. 

A study of one of the accompanying charts shows the values 
of some of the principal agricultural crops of the United States, 
and also that dairy products rank high in value. When we 
consider that where dairying declines other agricultural lines 
suffer great loss, and where agriculture is neglected or becomes 
unprofitable all business lines almost instantly respond to the 
decline, and if agricultural work is profitable then all other 



105 

business lines are profitable, we are justified in considering that 
dairying is an important industry in Massachusetts. 

To give an idea of the financial importance of dairying in 
Massachusetts the following figures are given: 147,000 milch 
cows at an average value of $60 each equals $8,820,000; 147,000 
cows yielding 5f quarts per day each at a value of 4 cents per 
quart equals $33,800 per day; $33,800 per day multiplied by 
365 equals $12,307,000 per year, as a rough estimate of the 
value of the present milk production in Massachusetts. Using 
figures of the New York Experiment Station on financing the 
cow, 147,000 cows at $680 each equals $99,960,000 to finance 
the cows of this State. 

If we estimate the number of people employed in caring for 
the milch cows of this State as 1 person per 8 cows, we have 
18,375 persons daily employed in this work. These figures show 
the dairy industry of Massachusetts to be important, and al- 
though it is impossible to say what the effect of the elimination 
of dairying in Massachusetts would be, it would certainly have 
a x very depressing effect on other lines of business activity. Any 
increase in the dairy industry of Massachusetts must certainly 
tend toward a greater prosperity for all connected with the 
agricultural interests of the Commonwealth and for those firms 
or individuals who rely upon the residents of the rural districts 
for their commercial success. 

D. THE COMMERCIAL PASTEURIZATION OF MILK AND 

CREAM. 

Pasteurization is the term applied to the process of heating 
a substance to a temperature sufficiently high to destroy or 
greatly reduce the bacterial content without causing appreciable 
chemical changes in the substance. The commercial pasteuriza- 
tion of milk as generally carried out in the State of Massachu- 
setts consists in heating the milk to a temperature of 145° or 
150° F., and holding the heated milk at a temperature of 142° 
to 144° F. for a period of from twenty to thirty-five minutes, 
after which it is immediately cooled. In a few instances, how- 
ever, dealers still employ the flash process of pasteurization, 
by which the milk is momentarily heated at a higher tempera- 
ture and is immediately cooled. 



106 

In the milk-pasteurization plants the milk is heated very 
quickly, generally under automatic temperature control and 
record, after which it is transferred to the holding chambers 
which may be of the continuous or of the intermittent type. 
In either case the temperature of the milk is usually recorded 
as the milk leaves the chambers for the cooler. In a few in- 
stances the milk is heated slowly in bulk, and held at the tem- 
perature of pasteurization for the necessary time in the same 
tank in which it was heated, after which it is cooled and bot- 
tled in the usual manner. 

The sale of milk heated to a temperature greater than 167° 
F. is prohibited in Massachusetts unless labeled "Heated Milk." 
This statute is difficult of enforcement, as it is almost impos- 
sible to determine by laboratory methods the exact tempera- 
ture to which milk has been heated, and in order to obtain the 
necessary evidence to prosecute for a violation of this law the 
investigator must see the milk pasteurized, and must of his 
own knowledge know the temperature to which the milk was 
heated. 

The first noticeable effect of heat upon milk is the production 
of a cooked taste which, however, depends to a large measure 
upon the temperature of heating. If the temperature is not 
too high this taste will disappear in eighteen or twenty hours. 
The chemical effect of heat on milk is the destruction of the 
so-called enzymes, and, as the temperature is increased, the 
coagulation of the albumin, and if a temperature greater than 
the boiling point is reached the sugar may be caramelized. 
The exact nature and significance of the enzymes present is a 
matter of controversy among those scientists who are trying to 
solve the problem, but a study, of the literature shows that 
milk gives reactions which may be explained by the presence 
of enzymes. Under this assumption it may be stated that raw 
milk contains a diastase capable of hydrolizing 0.01 to 0.02 
per cent, of starch, a catalase which will liberate oxygen from 
hydrogen dioxide, a peroxidase which will cause hydrogen 
dioxide to react with certain organic substances, thereby pro- 
ducing colors, and reductases capable of reducing methylene 
blue solutions to a colorless compound. These reactions are 
not only influenced by the temperature to which the milk is 



107 

heated, but by the length of time during which the temperature 
is maintained, and also by the age of the milk. The diastase 
is destroyed by commercial pasteurization, and this is also true 
of the formalin-methylene blue reductase, but this latter 
reaction returns three days after pasteurization, probably the 
reacting substance being reproduced by the growth of bacteria. 
The peroxidase reaction is not affected by the commercial 
pasteurization of milk, as shown by the work performed with 
this reaction in the Food and Drug Laboratory of the Massa- 
chusetts State Department of Health during the year 1913. 

As the destruction of this reaction is coincident with the 
coagulation of the albumin, and since the reaction may be a 
function of the albumin, it follows that there is undoubtedly no 
change in the milk proteins by commercial pasteurization as 
now practiced. When it is considered that milk with a cooked 
taste is liable to have a limited sale it is evident that the milk 
dealers will endeavor to keep the temperature as low as they 
possibly can and produce the required results. An added 
incentive to keep the temperature of pasteurization low is the 
fact that if milk is heated to a high temperature the cream 
does not rise well, and the bottle of milk will not show the 
cream line by which the public judge the quality of the milk 
they receive. 

Proper pasteurization will cause an enormous reduction in 
the bacterial content of milk, and, owing to the fact that 
pathogenic bacteria are killed at a lower temperature than 
most forms of lactic acid bacteria, the milk is rendered safe for 
food purposes and yet, provided that the temperature is not too 
high, is capable of going through the usual form of fermentation 
common to raw milk, thereby giving the consumer due notice 
of any undue age. 

Commercial pasteurization, however, is not carried on as a 
health measure, but purely for business reasons. It is for the 
interest of the large milk dealer to first preserve the large 
volume of milk he has on hand which he may desire to hold for 
a day or two before selling, and second, to distribute a safe 
milk in order to avoid possible damage suits owing to possible 
epidemics of disease among his customers. The latter is 
avoided by the pasteurization of the milk. Undoubtedly, old 



108 



milk and milk high in bacteria are pasteurized commercially, 
and no doubt much pasteurized milk is reinfected with bacteria. 



Bacteria pe/? C. C. 



I 

8 

r- 

\ 

I 

I 



5 
3 



y?A/y 



HEATED /4S.'/T 



MELD 30M/M 



x 


ti0Ff*% I 


£ 
X 


jir l iiii 




i\ I I IL 1 1 



\ 



COOLED 

BOTTLED 
/?AW 



//EATEDGHELD- 
/45°E-30WM. 



COOLED 

BOTTLED 
BAW 

HEATED /45"E 

HELD BOM/A/. 

COOLED 



BOTTLED 



The chart shows the influence of commercial pasteurization 
upon the bacterial content of milk, the statistics being obtained 
from the records of the New York City Department of Health. 
Two sections of the chart show good conditions in the pasteuri- 



109 

zation plants, and the third section shows poor conditions 
caused by contamination of the milk after pasteurization, or 
high bacterial content before pasteurization. The milk in these 
instances was degraded. If these conditions occur in super- 
vised supplies they must be very frequent in unsupervised 
supplies. 

The commercial pasteurization of milk should be under 
official supervision for the following reasons : — 

1. To prevent the pasteurization of milk high in bacteria. 

2. To prevent the heating of milk to a temperature sufficient 
to change its chemical composition. 

3. To see that the pasteurization is carried out in such a 
manner that the pathogenic bacteria are killed. 

4. To see that the milk is not reinfected after pasteurization. 



110 



PART IV. FACTS OP THE PRESENT OFFICIAL SUPER- 
VISION OF THE MILK SUPPLY OF THIS COMMON- 
WEALTH. 



A. PRESENT STATUS OF OFFICIAL SUPERVISION OF THE 
MASSACHUSETTS MILK SUPPLY BY FEDERAL, STATE 
AND LOCAL AUTHORITIES. 

Local Inspection. 

Local milk inspection is carried on under the provisions of 
chapter 405 of the Acts of 1909, which require that the boards 
of health of all cities shall, and the boards of health of towns, 
or the selectmen acting as such boards, may, appoint one or 
more inspectors of milk for their respective cities and towns. 
Each inspector shall be sworn before entering upon the per- 
formance of his official duties, and shall publish a notice of his 
appointment for two weeks in a newspaper published in his 
city or town, or, in the absence of such newspaper, shall post 
the notice in two or more public places in such city or town. 
The inspector shall keep an office, and shall record the names 
and places of business of all persons engaged in the sale of 
milk within his city or town. 

The boards of health may appoint a collector of milk. The 
inspectors or collectors may enter all places in which milk is 
stored, and all carriages used for the conveyance of milk, and 
may take samples for analysis. The inspector of milk shall 
license the persons engaged in the sale of milk, except pro- 
ducers selling milk to other than consumers or less than 20 
quarts per day to consumers. 

The statutes prohibit the sale of milk containing added water 
or any foreign substance, or as pure milk, milk from which the 
cream or any portion thereof has been removed. Skimmed 
milk may be sold if labeled as such in uncondensed Gothic type 
not less than 1 inch in length. The statute also prohibits the 
sale of milk containing less than 12.15 per cent, total solids, 
or less than 3.35 per cent. fat. There is a special provision 
allowing a producer of milk to sell milk below the standard 



Ill 

until twenty days after he has received written notice from 
the inspector that his milk is below the standard, both in 
solids and fat. The effect of this statute is to permit the pro- 
ducer to sell milk with total solids as low as 11.70 per cent., 
because such milk will invariably contain at least 3.35 per cent, 
fat. This milk cannot be sold by any person except the pro- 
ducer. 

Chapter 744 of the Acts of 1914 provides that it is unlawful 
for any person engaged in the milk business to sell or deliver 
any milk without first obtaining a permit from the board of 
health of the city or town where such milk is to be sold. This 
permit is to be issued only after an inspection, satisfactory to 
the board, of the premises upon which, and the condition under 
which, the milk is produced. The boards of health are also 
permitted under this act to make such reasonable rules and 
regulations as they may think suitable for protecting the pub- 
lic health. The duty of enforcing this portion of the act has 
been placed in the hands of inspectors of milk appointed for 
their respective cities or towns. If the board of health revokes 
a permit they shall immediately send notice of the fact to the 
State Department of Health, and the State Department of 
Health must then notify the boards of health of other cities 
and towns where this milk is liable to be sold, and any dealer 
in milk who is liable to sell it, of the action of the local board 
of health. After receiving such notice from the State Depart- 
ment of Health it is unlawful for any dealer to sell or offer for 
sale the milk from a dairy the permit of which has been re- 
voked. It is the duty of the State Department of Health to 
enforce this portion of this law. 

A careful study of the provisions of this act will show that 
if carried out as it should be there would be a needless dupli- 
cation of inspection on the part of many of our cities and 
towns. There is scarcely a city or town of any size in this 
State in which the milk dealers' supply is sold exclusively; for 
example, the milk sold in Boston is to a large measure sold 
also in Lynn, Salem, Peabody, Saugus, Melrose, Stoneham, 
Medford, Maiden, Winchester, Arlington, Belmont, Somerville, 
Revere, Chelsea, Cambridge, Watertown, Waltham, Newton, 
Brookline, Dedham, Milton and Quincy. The milk sold in 



112 

Springfield is to some extent sold also in West Springfield. The 
milk sold in Hopkinton, Holliston and Hopedale is also sold in 
Milford. Milk sold in Framingham is also sold in Natick, Wel- 
lesley and Sherborn. Nearly the entire milk supply of Methuen 
is from the same source which supplies the city of Lawrence, 
and milk dealers supplying Dracut, Chelmsford and Tewksbury 
also deliver milk in Lowell. Similar conditions exist in other 
portions of the State, although not to such an extent as in the 
vicinity of Boston. If this law was enforced as the statute 
contemplates, each farmer supplying milk to these various milk 
dealers would be subjected to inspection by the representatives 
of the boards of health of from 6 to 15 different cities or towns, 1 
and in many cases, even with the little enforcement this law 
has had, producers have been visited by at least three different 
inspectors and have been asked to comply with three different 
sets of rules and regulations. Even if the representatives of 
three or four different cities or towns did not visit the same 
dairies, the provisions of this act require them to make in- 
spections in the same territory. For example, the milk from 
dairies situated within 1 mile of each other in the Connecticut 
valley goes in some instances to Greenfield, in others, to North- 
ampton or to Springfield; and similarly in Cheshire the farmers 
are selling in some instances to North Adams, and in others to 
Pittsfield, making it necessary for inspectors of North Adams 
and Pittsfield to visit the town of Cheshire and examine dairies 
in that town in order to comply with the provisions of this 
act. Inasmuch as the provisions of this act have been carried 
out by but few localities, the needless duplication of inspection 
with its attending difficulties has been limited. 

State Inspection. 

State Department of Health. 

The State Department of Health is authorized by statute to 
expend annually a sum not exceeding $17,500 for the enforce- 
ment of the laws relative to the adulteration of food and drugs, 
three-fifths of which sum, or $10,400, shall be spent for the 
enforcement of the laws relative to the adulteration of milk 
and milk products. Under the provisions of this act the State 

1 Unless local boards of health made the employees of other boards their agents for dairy inspec- 
tion. 



113 



Department of Health collects and examines milk, butter, 
cheese, condensed milk, cream and ice cream. If any viola- 
tions of the law are discovered they are carefully investigated, 
and, if conditions warrant, prosecutions are made or further 
investigations started, with a view to prosecuting the respon- 
sible offender. 

The following list shows the number of samples collected, 
examined and prosecuted during the past eight years by the 
State Board of Health. 









Samples collected and examined. 


Prosecutions. 


Yeah. 




i 




§ 
-a 




a 






4^ 








t4 

© 

3 


(0 

o 

o 


a 
CI 

o 
O 


a 

o 

6 


o 
O 

t— 1 


"a 

o 


3 


1 


O 


1907, . 


2,992 


87 


15 


19 


26 


- 


3,139 


142 


5 


147 


1908, 






3,934 


54 


22 


38 


170 


- 


4,218 


214 


5 


219 


1909, 






4,611 


68 


22 


26 


171 


2 


4,900 


171 


9- 


180 


1910, 






5,396 


102 


15 


23 


104 


- 


5,640 


106 


13 


119 


1911, 






4,690 


30 


9 


28 


166 


- 


4,923 


78 


4 


82 


1912, 






4,900 


33 


6 


27 


100 


- 


5,066 


64 


1 


65 


1913, 






6,702 


58 


- 


8 


209 


132 


7,109 


101 


5 


106 


1914, 






6,008 


27 


3 


44 


284 


206 


6,572 


52 


6 


58 


Tot 


als, 


39,233 


459 


92 


213 


1,230 


340 


41,567 


928 


48 


1,066 



The State Department of Health has no power to make rules 
and regulations relative to the sanitary conditions of dairies, 
but dairy inspections have been made under the general pro- 
visions of the law creating the State Board of Health. The 
number of dairies inspected is given in the following table: 



Yeas. 



1907, 
1908, 
1909, 
1910, 
1911, 



Number 
of Dairies 
inspected. 



2,714 
2,231 
1,771 
2,053 
2,069 



Year. 



1912, . 

1913, . 

1914, . 
Total, 



Number 
of Dairies 
inspected. 



1,451 
4,493 

2,222 



19,004 



114 



Dairy Bureau. 

The Dairy Bureau of the State Department of Agriculture 
has an annual appropriation of $8,000 for inquiry into the 
methods of butter and cheese making, and for the enforcement 
of the laws relating to the sale of adulterated milk and milk 
products. The Dairy Bureau maintains a general agent whose 
salary is provided for by a special appropriation, and several 
other agents who obtain the samples and make the necessary 
investigations. The chemical work is all done by private chem- 
ists, being paid for at contract prices according to the number 
of samples submitted. The Dairy Bureau does but very little 
work relating to the adulteration of milk, but spends the 
largest amount of its appropriation enforcing the laws relative 
to the sale of oleomargarine. The Dairy Bureau reports that 
it has made no dairy inspections except those made in connec- 
tion with the clean milk and other contests. 

The following tables show the number of samples of milk 
and milk products examined by the State Dairy Bureau during 
the past eight years, and the number of prosecutions for the 
sale of adulterated milk and milk products. 

Samples collected and examined. 



Yeah. 



Milk 

and 

Cream. 



Butter 
and 
Oleomar- 
garine. 



Cheese. 1 



Con- 
densed 
Milk, i 



Ice 
Cream. 



Total 
Samples. 



1907, . 

1908, . 

1909, . 

1910, . 

1911, . 

1912, . 

1913, . 

1914, . 
Totals, 



192 
321 

90 
136 

35 
124 

94 

51 



1,182 
1,497 
1,779 
1,724 
1,282 
2,042 
3,458 
1,816 



1,043 



14,780 



1,374 
1,818 
1,869 
1,860 
1,317 
2,166 
3,552 
1,867 



15,823 



1 About 100 analyses of cheese and condensed milk are included with the butter and oleomar- 
garine figures. 



115 



Number of Prosecutions. 



Year. 



Milk. 



Cream. 



Butter. 



Oleomar- 
garine. 



Total 
Prosecu- 
tions. 



1907, . 

1908, . 

1909, . 

1910, . 

1911, . 

1912, . * 

1913, . 

1914, . 
Totals, 



60 



72 
51 
33 

77 

60 
88 

54 
27 



462 



111 
104 
168 
139 

157 
122 



982 



202 
169 
206 
220 
219 
216 
149 
129 



1,510 



Department of Animal Industry. 1 

The State Department of Animal Industry has charge of the 
examination of animals with respect to the presence of dis- 
eased conditions. The appointment of local inspectors is similar 
to that pursued in the appointment of inspectors of slaughter- 
ing. Nominations of inspectors of animals are made by the 
boards of selectmen of each city and town, which nominations 
must be approved by the Commissioner of Animal Industry 
before the inspector is appointed. The statute provides, under 
certain conditions, that a portion of the salary of these meu 
may be paid by the State. Inspections by these local inspectors 
of animals usually take place in the spring. 

If upon examination of the animals on a certain premises the 
inspector has reason to suspect the presence of any contagious 
disease, such animal or animals are quarantined, and the in- 
spector sends duplicate copies of such quarantines to the office 
of the Department of Animal Industry. A copy of the report 
is left with the owner of the animal, another one retained by 
the inspector, and the full record sent to the office of the De- 
partment of Animal Industry. At the time a copy of this 
record is left with the owner of the premises, such recommen- 
dations for improved conditions as may be necessary in the 
opinion of the inspector are brought to the attention of the 



1 The following rfisume' of the present status of animal inspection is directly compiled from a 
statement submitted by Dr. Lestor H. Howard, Commissioner of Animal Industry. 



116 

owner by that inspector, and the owner is requested to make 
such improvements. A later visit is made by the local in- 
spector, at which time, if conditions are found to be decidedly 
improved, the report submitted to the Department above re- 
ferred to credits the owner with the conditions found on the 
second visit, and in most cases it is found that the owners 
carry out the recommendations made by the inspectors. 

As a result, many of the cases that under a former plan 
would have been called to the attention of the District Agents 
of the Department of Animal Industry are satisfactorily dis- 
posed of locally, but if not so disposed of the District Agent is 
sent to the premises, the supervision of the Department of 
Animal Industry is directly given, and frequent visits made 
until the conditions are satisfactory. 

All cattle over six months of age coming into Massachusetts 
from any point without the State, if not intended for immedi- 
ate slaughter, are, according to law, tuberculin tested by an 
agent of the Department of Animal Industry, unless accom- 
panied by a certificate of test made by a man approved by 
the officials of the State wherein the shipment originates. All 
animals reacting to this test are destroyed. 

Federal Inspection. 

The United States Department of Agriculture, Bureau of 
Chemistry, has supervision over the interstate shipment of 
food including milk, and over the food introduced into this 
country from foreign countries. The Bureau of Chemistry has, 
until recently, taken little action upon the subject of milk. 
Some years ago Dr. Charles Harrington, then Secretary of the 
Massachusetts State Board of Health, endeavored to induce 
Dr. Harvey W. Wiley, then Chief of Bureau of Chemistry, 
United States Department of Agriculture, to prevent the ship- 
ment into this State of milk from dirty dairies in New Hamp- 
shire, and this the Department of Agriculture refused to. do. 
Two years ago Mr. Lythgoe endeavored to have the Bureau of 
Chemistry prevent the shipment of adulterated milk from 
Rhode Island into Fall River. This the Federal authorities 
refused to do. The United States Department of Agriculture 
has authority to absolutely prohibit the importation into this 



117 

country of any food, product which may be adulterated or mis- 
branded, or the sale of which may be prohibited in the country 
of its production. Under the provisions of this act the Federal 
government has recently had an inspector investigating the 
sanitary condition of dairies and creameries in Quebec. Action 
taken by the Federal government under this section of the law 
need not be passed upon by the courts. 

The Commissioner of Health of the State of Massachusetts 
has been made ex officio a Federal officer for the enforcement 
of the United States law relative to food samples shipped for 
sale into this State, and the analyst of this Department has 
been made the collaborating chemist of the United States De- 
partment of Agriculture. Under the provisions of these ap- 
pointments the State Department of Health of Massachusetts 
is able to exercise some control over the interstate shipment of 
foods, but as a rule the Federal law is difficult of application, 
and when adulterated milk from near-by cities or towns in 
other States has been shipped into Massachusetts, this De- 
partment has invariably succeeded in finding the producer of 
the milk in the State, and obtaining samples from him at the 
time of delivery to the purchaser. The interstate shipments 
of milk can best be controlled through the agency of the person 
buying the milk and selling the same in this State. 

B. PRESENT STATUS OF LOCAL MILK INSPECTION. 

The present statutes regarding local milk inspection were 
drawn with the contemplation that local inspection should in 
general be supreme. This is particularly true with reference 
to the influence of milk upon public health. Cities and towns 
have power to grant or refuse licenses to milk dealers, to issue 
or refuse permits to milk dealers or milk producers, and, what 
is of more importance, have power to make rules and regula- 
tions for the violation of which, or a refusal to comply with 
which, the license or permit may be rendered void by the author- 
ity by which it was issued. 

In order to ascertain to what extent the local boards of 
health exercised the authority the State had imposed upon 
them, a questionnaire and an addressed envelope was sent to 
all the local boards of health asking for information relative 



118 

to the character and amount of milk inspection done, the lo- 
calities where the dairies supplying milk were situated, the 
number of dairies from which the town obtained its milk, and 
a statement of any infectious diseases occurring in the city or 
town which may have been caused by milk. The analysis of 
this questionnaire is given elsewhere. 

A second set of questions and a stamped envelope was sent 
two months later to those boards making no reply to the first 
questions. Four months later a letter was sent to those boards 
from whom no reply was received, asking whether or not any 
milk inspection work was done, and the name of the person 
in charge of the work. This letter brought in a few more re- 
sponses, and three weeks later another letter was sent to the 
balance of the cities and towns making no reply, stating that 
in the absence of a reply it would be assumed that no milk 
work was done. Up to Dec. 1, 1915, no replies had been re- 
ceived from a number of towns with an aggregate population 
of about 3,500 people, or 1 per cent, of the total population. 

It was desired to obtain more exact, figures relative to the 
work done by local boards of health, and as this would have 
involved a larger amount of clerical work than the Board felt 
it could request the local authorities to perform for us, the in- 
spectors and analysts of the Food and Drug Division were sent 
to different milk inspectors, or agents of local boards of health, 
requesting permission to copy certain figures from the official 
records of their respective departments. These local officials 
showed every courtesy to our investigators, and gave all the 
information that they possibly could. 

A form was filled out for each town visited, and then the 
investigator copied from the local inspectors' books upon other 
forms the name and address of each licensed milk dealer, the 
number of wagons, whether or not the milk was pasteurized, 
the amount of raw milk sold, the amount of pasteurized milk 
sold, the name and address of the producers supplying the 
dealer, and the dates and scores of the dairy inspection made 
during 1914 and 1915. 

A card index of these various producers and dealers has been 
made, and we have at present a list of the names and addresses 
of the licensed milk dealers of this State, and the producers 



119 

supplying' them with milk, except the dealers and producers 
supplying the city of Boston. A perusal of the cards shows 
that with but few exceptions there is practically no duplication 
of inspection, and in many instances no inspection whatsoever. 
In completing these statistics the varied character of the work 
done in the different cities and towns has rendered it a difficult 
task to set forth the results obtained in a clear and concise 
manner. 

It has been found necessary, in order to make a proper com- 
parison of the work done, to divide the cities and towns into 
sixteen groups according to the character of their inspection 
work. In most instances it was found necessary to subdivide 
the towns in a group, for notwithstanding the fact that the 
character of the work performed entitles these towns to a posi- 
tion in the group, the amount of work performed was very 
slight in many instances. 

It was found that the replies to the questionnaire were in 
many instances misleading, most of which were in favor of the 
local boards making the reply. In one instance, however, 
where the local board stated that no milk inspection work was 
1 done, one of our inspectors found a milk inspector in the town 
doing good work. 

The fact that the local milk inspector had no records of 
dairy inspection does not necessarily imply that his work as 
regards actual inspection of the dairies is faulty or inefficient. 
Some of the inspectors have demonstrated to us the fact that 
their dairy inspection is productive of excellent results, although 
they make no dairy scores and keep no records of inspection. 
Many of these inspectors do not have the clerical help neces- 
sary to keep records in proper shape, and therefore may con- 
sider it futile to make any. In the case of death or resignation 
of an inspector, however, the department in which he was em- 
ployed has no records with which to ascertain the amount and 
character of work performed by the inspector. 

Using the 1910 population figures, 645,000 people, or 19 per 
cent, of the total population, received no protection relative to 
milk from their local authorities according to their own state- 
ment; and if we include the 1 per cent, who have not responded 
to numerous letters from the Department, the balance of 80 



120 

per cent., or 2,6S0,000, received some protection from their 
local authorities; 2,102,000, or 63 per cent, of the total popula- 
tion, are protected by some bacteriological work and some dairy 
inspection, and 1,446,000, or 43 per cent, of the total popula- 
tion, are adequately protected. The city of Boston represents 
670,000 people, or 46 per cent, of the population, so protected. 
Excluding Boston from these figures and recompiling, the re- 
sults are as follows: 25 per cent, of the population receive no 
protection, 53 per cent, are protected to some extent by bac- 
teriological examinations and by dairy inspection, and only 28 
per cent, are adequately protected. By adequate protection 
is meant frequent and careful inspection of dairies combined 
with frequent, reliable and thorough bacteriological examina- 
tions of milk. 

Qualifications of Local Milk Inspectors. 

While no attempt has been made to accurately summarize 
the qualifications of local milk inspectors, contact with the dif- 
ferent men has given quite an insight into their ability. These 
men range from those of the highest ability to those of very 
little ability. Some of them are physicians, some are chemists, 
some are pharmacists, some are veterinarians, some are men 
familiar with the production and sale of milk, and some are 
laymen. Many of these men are qualified only to grant li- 
censes, others with more ability specialize in dairy inspection, 
and have materially improved the conditions under which the 
local milk supply is produced and handled. Others add chem- 
ical analyses to their work, and still others do bacteriological 
work, and in general this work is performed in a creditable 
manner. 

Some without the necessary qualifications attempt to carry 
out complex analytical operations, and in some cases may have 
instituted prosecutions upon incorrect analyses. One such in- 
stance was brought to the attention of the State Department 
of Health. The local inspector in this instance asked for in- 
formation relative to the determination of nitrogen in milk by 
the Kjeldahl process, upon which determination he had based a 
prosecution. This inspector desired to inform himself concern- 
ing the process in order to be able to answer any questions 



121 

which might be put to him upon cross-examination. During 
the course of the conversation, it developed that the inspector 
had standardized his acid solution against a known weight of 
sodium hydroxide, which is never sufficiently pure for this pur- 
pose. Under these circumstances there might have been a pos- 
sible error as high as 20 per cent, in the determination. The 
inspector in this instance was given a correct method of stand- 
ardization, and found that the error was not sufficient to change 
his conclusions of the character of the sample. 

In many instances the laymen among the local inspectors 
have developed unusual skill in the analysis of milk, and have 
become efficient and valuable public servants notwithstanding 
their scientific and technical limitations. In the country dis- 
tricts the inspector is generally a farmer with the viewpoint of 
the producer who is selling his products. In the city the in- 
spector is generally a consumer with the viewpoint of the man 
who is buying milk. When these two classes of inspectors come 
in contact with each other by working in the same territory 
there develops a material difference of opinion. An example of 
this was shown in the reports of inspections made in one town 
received from two such inspectors. ' The local man had in- 
spected all. the dairies, and in his opinion they were in proper 
shape to produce milk for sale anywhere. The inspector of a 
city many miles away where the milk was sold inspected the 
same dairies and excluded the milk of about 25 per cent, of 
them on account of dirty premises and unsanitary conditions 
of production and handling. 

The salaries paid to these local inspectors are, on the whole, 
inconsistent with the necessary qualifications for the positions. 
Communities should realize that unless they pay the price they 
cannot get the services of competent men, even if in some in- 
stances competent men are serving as local inspectors of milk 
without adequate compensation. 

C. DISCUSSION OF PRESENT SYSTEM OF DAIRY IN- 
SPECTION AND ITS SANITARY VALUE. 

The system of dairy inspection carried on at present in this 
country is that outlined by the United States or some similar 
dairy score card, although the former is the one which is most 



122 

used for the reason of uniformity in comparison. This score 
card allows a total of 40 per cent, for equipment and a total 
of 60 per cent, for methods. Under methods 8 per cent, is 
allowed for cleanliness of the cows, 6 per cent, for cleanliness 
of the stable, 8 per cent, for cleanliness of the utensils, 9 per 
cent, for cleanliness during milking, and 16 per cent, for the 
cleanliness and care in handling of the milk. Under equipment 
6 per cent, is allowed for the health of the cattle, 6 per cent, 
for the location and construction of the stable, 11 per cent, for 
light and ventilation, 9 per cent, for construction and character 
of utensils, and 6 per cent, for the milk house. It is a -well- 
known fact that clean milk can be produced in dirty stables, 
provided that the milker is a clean man and cow has been 
thoroughly cleaned before milking, but under ordinary circum- 
stances milk obtained from dirty cattle housed in dirty stables 
is liable to be dirty milk. This score card has been severely 
criticized on the grounds that too much stress is laid upon 
equipment and too little on methods. 

A questionnaire was sent to the various food commissioners 
of the different States early in the present year asking, among 
other questions, whether §r not the United States score card 
was of any practical value in improving dairy conditions, and 
what changes it would be advisable to make in order to im- 
prove the card. Twenty-four replies were received, all answer- 
ing the first portion of the question in the affirmative. To 
the second portion of the question three persons suggested 
that no change need be made, but 11 others suggested changes, 
the majority of which were to the effect that more value should 
be given to methods and less to equipment. The character of 
the replies were very characteristic of the personnel of the 
various departments. For example, replies from health boards 
only stated that more stress should be placed upon cleanli- 
ness of attendants, health of cattle and medical inspection of 
attendants. One, a director and chemist of an experiment sta- 
tion, replied that the dairy inspections should be supplemented 
by chemical and bacteriological examinations of the milk and 
the water. 

It is evident by the replies received from these various food 
commissioners that the score card has in their opinion resulted 



123 

in improved dairy conditions. It is undeniably true that if 
dairy conditions are improved dairy products must of necessity 
be improved. 

Because of the facts that an exceptionally clean man can 
produce clean milk in a dirty stable, and a dirty man cannot 
produce clean milk even in a clean stable, certain opponents of 
inspection of dairies or of other forms of inspection directed 
towards farmers seem to advocate the theory that the proper 
way to produce good, clean milk is to have dirty stables as the 
first requisite. The consumer, however, is now demanding that 
the factories in which his food is prepared, warehouses in which 
it is kept, and the stores in which it is sold, shall be clean. 
The consumer is now demanding that the dairies from which 
his milk is produced shall be clean, but if he is educated to the 
belief that producers of milk need not keep their premises 
clean, the consumer is liable to abstain from the use of milk, 
and the dairyman loses his market. 

The soore card, however, is of the highest educational value 
to the farmer by pointing out the measures for producing clean 
milk upon old premises. If a dairy farm scores very low, and 
the farmer desires to produce a better article, or if he is paid 
a higher price for a better article, he can easily improve the 
score, and consequently the character of the milk, by improv- 
ing the methods and to a slight extent the equipment. 

The purchase of a small-top milk pail increases the score by 5 
per cent., washing and wiping the udders before milking increases 
this portion of the score to 6 per cent., removing the milk im- 
mediately from the stable without pouring from the pail adds 
2 per cent., coolmg immediately after milking adds 2 per cent, 
more, and cooling, storing and transporting below 50° F. adds 
10 per cent, to the score. This procedure increases the total 
score by 25 per cent., and if the stable was dirty and the cows 
were not tuberculin tested the dairyman by remedying the de- 
fects may add 11 per cent, more to the score, and by building 
and equipping a milk room and keeping it clean may add 5 
per cent, more to the score. Thus it is apparent that if this 
portion of the score card is lived up to both the quality of the 
milk and the score of the dairy will be improved. 

In order to see whether or not there was any uniformity in 



124 

the dairy scores in different parts of the country, and to ascer- 
tain the mathematical difference between a clean and a dirty 
dairy, the scores obtained by the Milk Board upon their various 
trips were taken, computations made, and the computations 
plotted in such a manner that the various scores of different 
portions of the score card could be made comparable with each 
other. It was found that as a general rule the dairies scored 
relatively higher in methods than they did in equipment, show- 
ing that the dairymen appreciated the value of good methods 
in improving the product. It was found, however, that those 
dairies supplying milk to the "contractors" were not in such 
good condition as those ' located near and sending milk to large 
cities. The scores of 117 dairies supplying near-by cities, and 
the scores of 124 dairies supplying contractors, were separately 
combined and plotted, the resulting plot showing that the con- 
tractor's dairies were somewhat inferior to those supplying milk 
to near-by cities. This was particularly noticeable in that por- 
tion of the score relative to cleanliness of stable. Thirty-five 
per cent, of the contractor's dairies scored for cleanliness of 
the stable, and 15 per cent, scored only 1.3 per cent. Of the 
dairies supplying near-by cities none scored for cleanliness 
of stable, and only 8 per cent, scored as low as 1.2 per cent. 
Fifty-eight per cent, of the dairies supplying near-by cities 
scored 3.5 per cent, on cleanliness of stable, but only 15 per 
cent, of the contractor's dairies reached this score. The sys- 
tematic inspection on the part of agents of local boards has 
had an influence upon those dairies located near their re- 
spective cities and' towns, resulting in improved conditions at 
the dairies. These conditions are due to the* fact that if the 
farmer is paid a sufficient price to make it profitable to pur- 
chase good utensils and to keep his stable - clean he will do so. 
The farmers supplying milk to the large contractors receive 
on an average from 1.5 to 2 cents less per quart than the 
farmer selling to a dealer delivering milk in a near-by city, 
and, therefore, cannot afford to take the care of the milk and 
the stable that the dairyman does who receives more money. 

Dairy inspection is of value in increasing the sanitary quality 
of milk in those communities where it is rigidly enforced, and 
particularly so where milk is sold upon its sanitary value. It, 



125 

however, should, be almost entirely educational, because it is 
the milk and not the stable which is consumed, and, therefore, 
the inspection and the improvement of the milk rather than 
the stable should be the prime object. There is no doubt, 
however, that the dairy inspection which has been carried on 
in this State for the past eight years has resulted in an im- 
provement of dairy conditions and of the milk supply, and for 
this reason dairy inspection is highly desirable. 



126 



PART V. THE RELATIONSHIP BETWEEN COW'S MILK 
AND THE PUBLIC HEALTH. 



A. INTRODUCTION. 

The enormously diversified individual conditions under which 
cow's milk becomes an important factor in human health or 
disease may be reduced to three great groups: — 

I. The relationship between the use of cow's milk, or milk 
products, and certain infectious diseases of man. 

II. The relationship between the use of cow's milk as a 
substitute for human milk and the death rate of infants. 

III. The relationship between the use of cow's milk, milk 
products and derivatives, and the sustaining of that balance 
of the processes of destruction and repair within the human 
body that is commonly known as a state of health, or, in other 
words, the relationship of milk to human nutrition, or the 
metabolism of milk. 

The first two of these groups have one common ground in con- 
trast to the third. They represent the health-menacing possi- 
bilities of milk. The last represents the health and life sus- 
taining properties of milk as an everyday article of diet. 

Perhaps the most unfortunate thing about the entire litera- 
ture of milk — about the present agitation relative to the use 
of cow's milk throughout the country — is the slight amount 
of emphasis that has been placed on the value of milk as con- 
trasted to the dangers of milk as an everyday article of human diet. 

Milk as an incubator of infections, the limitations of the cow 
as a substitute for the human mother, the connection between 
dirty, stale and decomposed cow's milk and the summer scourge 
of the innocents, — all these themes have been worn thread- 
bare, all have been argued to the point of exhaustion, and all 
more or less conclusively proved. But the beneficent role 
played by the maligned cow even under the most adverse con- 
ditions, in stepping into the breach between life and death 
when mothers fail, has received all too scanty emphasis. 



127 

It may even be seriously questioned, whether some of the 
well-intentioned popular agitation, relative to the disease-bear- 
ing possibilities of milk, has done as much service to the cause 
of humanity, by pointing out the existence and insisting upon 
the correcting of certain very real and serious dangers, as they 
have done injury to that cause by inducing an exaggerated 
fear of cow's milk as it is produced and handled at present. 
This fear, in turn, has led to attempts to substitute for cow's 
milk other materials and products that in the long run are 
vastly more inimical to human health in general, and to that 
portion of humanity designated as infancy in particular. 

It may be held that such statements as the foregoing are 
damaging to the "clean and safe milk" cause; that any re- 
sponsible officials making such statements are placing them- 
selves in the position of apologists for the cause of dirty and 
disease-producing milk. Far from it. Such statements simply 
indicate that the other side of the problem should receive its 
fair consideration. 

In the United States during the past thirty years it has be- 
come firmly established by law and by the general consensus 
of public opinion that the business of producing and distribut- 
ing cow's milk has such extensive and direct relations to the 
public health and welfare that it is justifiable, through an exer- 
cise of that police power which resides in all organized govern- 
ment, to interfere with the commercial processes of that busi- 
ness to an extent that is hardly approached in any other line 
of commercial enterprise. In direct proportion to the growth 
of such sentiment — permitting, even demanding, this extraor- 
dinary interference in the name of the public health with a 
legitimate life-supporting industry — it becomes more and more 
important that this police power be exercised with sanity, dis- 
crimination and fairness to all concerned. 

Exaggeration of the dangers of milk as they are, and an in- 
sistence upon non-essential, whimsical, illogical and excessively 
costly measures of alleged protection of the consumer's milk at 
the present, are never going to successfully solve the problem 
of safe, clean and honest milk for the consumers in the future. 

Perhaps there is no service in relation to the milk question 
that is needed so much to-day as a clear, unbiased statement 



128 

of the relative evils and benefits of cow's milk to the human 
race as conditions are at present. 

With this clearly fixed, with the excessive overstatements of 
present dangers and the moral responsibility of the deliberately 
dirty or careless producer, dealer and consumer equally clearly 
understood, the public, who is the final arbiter in the whole 
matter, can more clearly and intelligently fix and determine, 
through its representatives and duly authorized agents, the 
degree of refinement of methods that it considers reasonable 
and essential for its own best interests, and the price that it 
is willing to pay to institute such minimum standards of quality 
as it may determine upon as' necessary in the interests of the 
public health and welfare. 

B. MILK AND THE COMMUNICABLE DISEASES. 

The more important diseases of man that milk may play an 
important role in transmitting are tuberculosis, diphtheria, scar- 
let fever, typhoid fever and septic sore throat. 

The question as to the connection between milk supply and 
the transmission of these diseases under certain circumstances 
is no longer open to debate. It has been proved beyond reason- 
able doubt. The phases of the problem that are still open to 
discussion are (a) how great a relative danger in the transmis- 
sion of these diseases is milk as at present produced, and- (6) 
what are the most reasonable, efficient and economical protec- 
tive measures that can be adopted to reduce the risk of such 
disease transmission through milk to a minimum? 

1. Milk and Tuberculosis. 

Broadly speaking, among the various human diseases that 
may be transmitted by infected milk tuberculosis occupies a 
unique position. This is due to the fact that in all the other 
important milk-borne diseases the infective agency is human, 
and comes into play after the milk has been drawn from the 
cow. In the transmission of tuberculosis it is possible that 
subsequent accidental infection of milk and milk products, due 
to human tubercle bacilli, may occur, but the great source of 
danger as regards tuberculosis transmission through milk is the 
cow herself. 



129 

So much confusion still exists relative to the connection be- 
tween animal and human tuberculosis, due to the great con- 
troversy that raged in regard to it from 1901 to 1911, that 
although the questions at issue are now definitely settled, it is 
perhaps advisable to refer to them briefly in order to make 
our present problem perfectly clear. This seems the more de- 
sirable in the present report from the fact that your Board 
has found several among the milk producers of this Common- 
wealth who are under the seriotis misapprehension that good 
scientific authorities still deny the transmission of tuberculosis 
through milk. 

Following the demonstration of the tubercle bacillus in 1882 
by Koch, it was taken for granted by all the scientific world 
that the two diseases, human and bovine, were identical, and 
readily and mutually transferable. His later discovery of tuber- 
culin in 1890, and its rapid application to dairy animals for 
diagnostic purposes, quickly demonstrated that tuberculosis was 
more prevalent among dairy animals than had been previously 
suspected. This discovery led to a veritable epidemic of sani- 
tary live-stock legislation directed against tuberculosis in cattle, 
which spread over nearly all civilized countries during the 90's. 
Prominent among such laws were the " tuberculin testing and 
slaughter of reactors" laws of Massachusetts. 

Meanwhile, in 1896, Prof. Theobald Smith demonstrated that 
the human and bovine types of the tubercle bacillus were not 
identical, but possessed quite distinctive differences both in 
appearance, in reactions on culture, and in their relative viru- 
lence to different animals when injected experimentally. 

In 1901 Koch read his famous paper in London, in which he 
clearly gave the impression to all the world that there was ho 
relationship whatever between human and bovine tuberculosis. 
It is not true, as has been often alleged, especially by some who 
have sought to minimize or deny all relationship between hu- 
man and bovine tuberculosis, that Koch said that the bovine 
bacillus and the human bacillus were two different germs. He 
simply said they were two types of the same species, a point 
Prof. Theobald Smith had long before made clear. But he did 
state very emphatically his opinion that the two had little in 
common. To quote the words of Professor Welch of Johns 
Hopkins, "Koch certainly left the impression by the conclu- 



130 

sions drawn from his own words that there was practically no 
danger whatever of infection from bovine sources;. Koch drew 
that inference without basis of facts." 

The controversy that this opinion of Koch's immediately 
aroused and the great practical importance of the subject pre- 
cipitated one of the most intense investigations into the true 
nature of any communicable disease that has ever been known. 
The British government appointed a Royal Commission which 
worked continuously for ten years upon the subject. The Ger- 
man government appointed a similar commission, and these two 
commissions and other investigators the world over, especially 
those of the New York City Health Department in this coun- 
try, carried on researches for years into every conceivable phase 
of the great problem. 

These researches all came to one general conclusion, which 
can perhaps best be stated in the words of the British Royal 
Commission in their final report in 1911. The following ques- 
tions were submitted to them for investigation : — 

Question 1. — As to whether the disease in animals and man is one and 
the same. 

Conclusion. — Whether one prefers to regard bovine tuberculosis and 
the cases of tuberculosis in man, which are caused by the human type of 
bacilli, as varieties of the same disease or as independent diseases, there 
can be no question that human tuberculosis is in part identical with 
bovine tuberculosis. Our researches have proved that in a considerable 
proportion of cases of the human disease the lesions contain, and are 
caused by, bacilli which in every respect are identical with the bacilli 
which are the cause of tuberculosis in cattle. In all such cases, therefore, 
the (human) disease is the same disease as bovine tuberculosis. 

Question 2. — Whether animals and man can be reciprocally infected. 

Conclusion. — We must conclude that mammals and man can be 
reciprocally infected with the disease tuberculosis. 

Question 8. — Under what conditions, if at all, the transmission of 
tuberculosis from animals to man takes place, and what are the circum- 
stances favorable or unfavorable to such transmission. 

Conclusion. — Whatever may be the animal source of tuberculosis in 
adolescents and in adults, there can be no doubt that a considerable 
proportion of the tuberculosis affecting children is of bovine origin. 

And again: — 

It may be asked in what way are children . . . most likely to obtain 
a large and fatally infective dose of tubercle bacilli? ... To this question 



131 

there can be but one answer, namely, that ... a considerable amount 
of the tuberculosis of childhood is to be ascribed to infection with bacilli 
of the bovine type transmitted to children in meals consisting largely of the 
milk of the cow. 

The fact of the existence of bovine tuberculosis infection in 
human beings once demonstrated, the all-important question 
from the standpoint of practical safeguarding of the milk sup- 
ply of any nation, State or community is, how great a danger, 
how great a menace to human life is this transmission of bovine 
tubercle bacilli to man? And what are the most logical steps 
to be taken to minimize or entirely eradicate this danger? 

From the careful and extensive investigations of Park and 
Krumwiede, of the New York City Health Department, it 
would appear that at least one-third of all cases of tuberculosis 
in children under five years of age are due to bovine bacilli, 
and nearly as great a proportion in cases occurring in children 
between five and fifteen years of age. 

It would also appear that the bovine type of bacillus is prac- 
tically never found in adult pulmonary tuberculosis or con- 
sumption, but this does not necessarily mean that infection in 
childhood by< the bovine tubercle bacillus has no relation to 
the occurrence of adult consumption. 

When consumption is excluded, the percentage of adult tuber- 
culosis due to the bovine tuberculosis in the large series of 
cases so exhaustively investigated rises to 7.3 per cent. Various 
leading authorities, American and foreign, are in substantial 
agreement that at least 5 to 7 per cent, of tuberculosis in hu- 
man beings is definitely and directly of bovine origin. And 
the possibility of the true percentage being still higher cannot 
be denied. 

In addition to these well-demonstrated dangers to the human 
race from tuberculous milk, two other theories have been ad- 
vanced and have received very serious attention from the 
world's best authorities on tuberculosis. 

The first theory is based on the fact that after all, the dif- 
ferences between the human and the bovine tubercle bacillus 
are merely differences of type or of degree. They cannot be 
considered as distinct, fixed species. Or, to use the apt illus- 
tration of Professor Ravenel, the differences between human 



132 

tubercle bacilli and bovine tubercle bacilli are analogous to the 
differences between a Jersey cow and a Holstein cow, rather 
than to the differences between a cow and a horse. With this 
admitted, it is entirely conceivable that bovine bacilli might 
be taken into the body in childhood, and after a lapse of years, 
by spontaneous breeding in human tissues, finally take on the 
essential characteristics of the human bacillus in much the same 
manner as a farmer may greatly change the characteristics of 
his final product in any field crop by seed selection extended 
over a period of years, without introducing any outside seed. 
If this does actually occur, if bovine bacilli, taken into the 
child's body through milk, under the influence of a human en- 
vironment, in the course of many, many generations of germ 
life, approach the human bacillus type, and finally become 
manifest as active tuberculosis in the adult, then, the bacilli 
recovered showing human characteristics, the infection would 
naturally be ascribed to human origin although in reality bo- 
vine. There are some facts that tend to support this view, 
but the majority of authorities are not inclined to believe in 
it, although no one can yet positively deny its correctness. 

The other theory has received much more favorable consid- 
eration, and it is perhaps not putting it too strongly to say 
that certain of its originally assumed conditions are beginning 
to be quite firmly established as facts. Without going into de- 
tails that would be entirely out of place here, it is enough to 
say that the fundamental concept of this view is simply that 
certain infections with bovine tubercle bacilli in early child- 
hood, which at the time cause very slight or no visible consti- 
tutional symptoms, may be an important factor in the devel- 
opment of tuberculosis later in life by rendering the person 
less resistant to heavy doses of the human bacilli than he 
would otherwise have been. 

Other points of great significance in the relationship of milk 
to tuberculosis are: how many of our dairy cows are tuber- 
culous; which ones among the tuberculous animals are dan- 
gerous to the consumer of raw milk; and how relatively 
frequent is the occurrence of bovine tubercle bacilli in ordinary 
market milk, cream, butter, etc. 



133 

A complete discussion of the first point would take us too 
far into the field of veterinary medicine. Suffice it to say that 
while absolutely reliable figures for all the dairy cattle of any 
nation or State do not exist, such authorities as Chief Melvin 
of the Federal Bureau of Animal Industry and Professor Moore 
of Cornell concur in the opinion that not less than 10 per cent, 
of the dairy cows of the United States are affected with bovine 
tuberculosis. M'Fadyean, an eminent British authority, esti- 
mates that 30 per cent, of British cows are tuberculous. In 
Massachusetts over a period of fifteen years, from 1893 to 
1908, out of a total of 86,223 animals tested, 11,853 reacted 
to the tuberculin test for tuberculosis, 10,760 of them were 
slaughtered and 10,688, or 99.34 per cent., were found definitely 
tuberculous at post-mortem examination. It is interesting to 
note that although comparatively few examinations are being 
made at present in this State, it seems to be quite a universal 
opinion among the older milk producers interviewed that bo- 
vine tuberculosis is relatively much less frequent among the 
Massachusetts dairy cows than was the case twenty years ago. 

These figures are enough to show the great extent of the 
disease tuberculosis among dairy cattle. 

The evidence is now complete showing that tubercle bacilli 
are excreted in large numbers in the dung of tuberculous cows, 
and that this occurs even when there is no lesion of the ani- 
mal's intestines. 

It is also quite universally agreed that at le'ast 2 per cent, 
of tuberculous cows suffer from tuberculos'is of the udder. In 
this disease prodigious quantities of bovine tubercle bacilli pass 
directly into the milk with every milking, but under present 
conditions it is more than likely that even more tubercle bacilli 
in the aggregate pass into the milk from the dried dung of the 
tuberculous animals. 

Two or three other points bearing upon the same subject are 
of great practical significance. 

(a) That the clinical diagnosis of tuberculosis in cows is rec- 
ognized as impracticable in all except the well-marked cases. 

(b) That extremely small amounts of milk from cows suf- 
fering from udder tuberculosis are sufficient to produce tuber- 



134 

culosis experimentally in animals when administered, by inocu- 
lation. 

(c) That tuberculosis can be induced with varying degrees 
of readiness in various animals by feeding tuberculous milk 
(i.e., milk from cows suffering from tuberculosis of the udder), 
and, what is more significant, in none of the considerable series 
of animals so tested by the British Royal Commission did this 
occur more readily than in the anthropoid apes, their relative 
susceptibility being much higher than that of calves. 

(d) That samples of unselected raw market milk taken at 
random from the city milk supplies of many European and 
American cities have been proved by the work of many in- 
vestigators to contain virulent bovine tubercle bacilli in from 
2 to 50 per cent, of samples taken, with an average of between 
10 and 20 per cent, probably predominating. 

Without going into any details, it is obvious that there are 
only two conceivable general lines of action that will be prac- 
ticable in coping with the problem of minimizing or eradicating 
the danger of bovine tuberculosis to the human race. They 
are either the practical extermination of bovine tuberculosis, 
or such universal treatment of cow's milk as would render it 
safe and inocuous from the standpoint of transmitting tuber- 
culosis, even though it may originally have contained more or 
less tubercle bacilli. As a practical procedure it is, of course, 
necessary that both lines of action be followed. 

The struggle against bovine tuberculosis among dairy herds 
is a subject that does not strictly pertain to this report, inter- 
esting though it would be to review some of its more salient 
features. It must be admitted that up to the present time the 
total progress in this line, while by no means negligible, cannot 
be. considered as sufficient to give us any sound basis upon 
which to base any hope of eliminating the menace of bovine 
tuberculosis by this means in the near future. Certain im- 
portant subsidiary measures should never be neglected, such 
as careful veterinary inspection of herds to rule out tuber- 
culosis of the udder, and insistence upon such standards of 
dairy cleanliness in general, and of clean methods of milk- 
ing in particular, as will guarantee a minimum possibility of 
tubercle-infected dung finding its way into the milk. But the 



135 

surest, most economical and quickest method that has ever yet 
been devised to bring about the end in view, namely, the per- 
fect safeguarding of the milk supply as regards bovine tuber- 
culosis, is through the resort to the process of pasteurization. 
Pasteurization in its relation to communicable diseases in gen- 
eral will be considered later. It is sufficient to make the defi- 
nite, emphatic statement here that pasteurization properly per- 
formed will undoubtedly remove all danger of transmission of 
tuberculosis through milk. 

2. Methods of Infection of Milk by Diphtheria, Scarlet Fever, 
Septic Sore Throat and Typhoid Fever. 

That milk is a most favorable medium for the growth of 
specific organisms of certain infectious diseases of man has been 
demonstrated by Eyre. He found that typhoid bacilli were 
multiplied in healthy cow's milk 6,000 times in twenty-four 
hours, while diphtheria bacilli increased more than 1,000 times 
during the same period. However, this experimental work was 
done upon milk obtained under sterile conditions. Your Board 
has not found any reliable data upon the amount or rate of 
increase of pathogenic bacteria in unsterilized milk under or- 
dinary conditions of temperature. It can be readily seen that 
in the presence of the many non-virulent types of bacilli found 
practically universally in raw milk, the question of determining 
just how rapidly growth of disease-producing bacteria occurs is 
practically insoluble. The presence of acid-forming bacteria in 
milk checks their growth, but cannot be relied upon to kill any 
contained typhoid bacilli (Savage). Their viability has been 
determined by Hesse and Field, who found the typhoid bacilli 
to survive as long as four months in sterilized milk. It is, 
therefore, readily seen how small particles of infection conveyed 
to milk may infect large supplies in the mixing and handling, 
and in turn may infect susceptible individuals who drink the 
raw milk. Of the infection of milk from human sources there 
is now abundant evidence. Rosenau writes that "the more 
serious infections in milk come from human origin." It may 
be conveyed directly or indirectly. Typhoid infection may be 
conveyed directly to the milk by the person taking care of the 
patient, whose other duties, after taking care of the patient 



136 

and handling soiled bed linen, include the care and handling 
of milk. A source determined in recent years to be quite com- 
mon is the carrier or person who shows no symptoms of the 
disease, but whose excreta contain the infection. These find- 
ings have been duplicated so many times now as to become 
commonplace. Twice in this State during the present year has 
the same point been completely determined, — in one instance 
in a carrier who had the disease five years previous, and in the 
other in a carrier who had the disease at least thirty-five years 
previous. Lumsden and Woodward cite an* instance of a woman 
milker on a dairy who had typhoid fever eighteen years before 
the outbreak which was attributed to her. Typhoid bacilli 
were found in large numbers in her feces. No other source 
could be found to account for the infection in the milk. 

Still another source of direct infection comes from the con- 
valescent whose feces and urine still contain the bacilli, and 
who is not sufficiently isolated from the milkers or others han- 
dling milk. 

Indirectly, typhoid infection may get into the milk through 
the medium of sewage-polluted water used for washing the 
milk utensils, or by fraudulently adulterating the milk with 
specifically polluted water. 

Diphtheria infection of milk most usually occurs directly 
from persons engaged in milk production or in the handling 
of milk while suffering with a mild or unrecognized form of 
the disease; or by persons similarly employed who show no 
symptoms of the disease, but who carry the bacteria in the 
nose and throat; or by such persons coming in contact with 
milkers or others handling milk. Bacteriology now plays an 
important role in the discovery of milk-borne epidemics. Out- 
breaks have occurred where persons employed as milkers, upon 
bacteriological examinations have shown the presence of viru- 
lent diphtheria bacilli in their throats. Klein, through experi- 
ments, has tried to show the possibility of bovine diphtheria, 
but practically all the present-day authorities hold that there 
is no evidence that the diphtheria bacillus is ever of bovine 
origin. That teat ulcers may be secondarily infected with diph- 
theria bacillus by milkers has been demonstrated. Dean and 
Todd in 1902 described a small outbreak in which diphtheria 
bacilli were isolated from the teat lesions and from the milk. 



137 

Through human channels the virus of scarlet fever may be 
introduced into the milk in similar ways to that of diphtheria. 
The usual way is from an unrecognized case coming in contact 
directly or indirectly with the milk supply. Harrington records 
an extensive outbreak as being caused by a man employed to 
taste milk, who used the same spoon in sampling each lot of 
milk. The daughter of this man was found to be desquamating, 
and he himself showed symptoms of the disease. The possi- 
bility of bovine infection with scarlet fever has been studied 
by Klein in connection with the Hendon outbreak of 1885, and 
while his views were favorable, they have been strongly op- 
posed by other observers. Rosenau states that "Cows do not 
have typhoid fever, diphtheria or scarlet fever." 

As to the possibility of bovine streptococcus infection being 
the cause of septic conditions in the throat of man, Theobald 
Smith states, "There is at present no satisfactory evidence that 
bovine streptococci associated with mastitis or garget are the 
agents of tonsillitis in man." From the results of certain ex- 
periments conducted by Savage, it is suggested that under 
ordinary conditions bovine streptococcus mastitis is not a cause 
of human disease. Rosenau says, "It is assumed that the in- 
fection usually gets into the milk from human sources, although 
it is suspected that streptococci eliminated by diseased udders 
may be responsible for some outbreaks." Milk-borne outbreaks 
of septic sore throat in this country, after careful investiga- 
tion, have failed to disclose any disease of cows sufficient to 
account for the infection. 

3. Communicable Diseases of Minor Significance or Relative 
Infrequency, in which Milk is concerned as an Agent of 
Transmission. 

Although there are several other communicable diseases, 
which are transmitted through the medium of infected milk, 
tuberculosis, diphtheria, scarlet fever, typhoid fever and septic 
sore throat comprise all the communicable diseases of man, in 
whose transmission cow's milk ever becomes an important fac- 
tor, that are of any practical importance in the State of 
Massachusetts. 



138 



4. The Evidence available as to the Relative Importance of 
Milk as a Means of Transmission of Communicable Diseases, 
as compared with Other Means of Transmission. 

Incidental reference has already been made to this part of 
the public health problem of milk in considering the individual 
diseases, but certain generalizations on this point are needed 
to make the exact status of the problem clear. 

One point, and only one point, can be considered as settled, 
viz., that cow's milk from either animal {e.g. in tuberculosis) 
or human {e.g. in typhoid) sources may, and more or less fre- 
quently does, become infected, and thereby under certain con- 
ditions subsequently becomes the causative factor in the trans- 
mission of such diseases to man. But the all-important ,ques- 
tion in this connection at once arises as to just how great a source 
of danger milk is in this respect under our present conditions. 

It is not very nattering to the present condition of American 
epidemiology to be obliged to report that it is impossible to 
give even a roughly approximate estimate upon this extremely 
important and practical point. 

One point that needs to be firmly kept in mind is that prac- 
tically all of our present information, with one or two notable 
exceptions, relates to milk as a disease factor under epidemic 
conditions only. No State in the United States makes a suf- 
ficiently careful study of its communicable diseases to give a 
reliable basis upon which to form any opinion in regard to the 
relative importance of infected milk in the occurrence of the 
so-called sporadic or isolated or endemic cases of typhoid, diph- 
theria or scarlet fever. 

Tuberculosis is a disease that is never epidemic; in all cir- 
cumstances it must be regarded as of sporadic or endemic 
origin. The reasons why as yet it is impossible to state with 
any degree of certainty the possible maximum effect of tubercle 
bacilli infected milk upon the prevalence of human tuberculosis 
have already been explained. But all of the othar serious com- 
municable diseases of man that, so far as we know, are in part 
spread through infected milk occur in both epidemic and en- 
demic or sporadic form. 

Looking at the problem of the relation of milk to the public 
health in its entirety, in order to give it its proper weight and 



139 

proportion compared to other health problems, it is highly de- 
sirable to know just how great a factor in both the epidemic 
and endemic occurrence of typhoid, scarlet fever, diphtheria 
and septic sore throat infected milk actually is. Obviously, if 
it were possible to prove, or even if it were possible to deduce 
strong presumptive evidence to indicate that milk infection is 
a 75 per cent, factor in the total incidence of these diseases, 
then our obligations to the public health would justify, even 
demand, the advocating of prophylactic measures much more 
drastic and expensive than would be indicated if, on the con- 
trary, infected milk could only be demonstrated to be respon- 
sible for 1 or 2 per cent, of the total incidence of these same 
diseases. 

In the one instance almost any expense and stringency of 
sanitary regulations could be justified, for by their vigorous 
application there would be every opportunity to rapidly de- 
crease the prevalence of these diseases to such an extent as to 
render their total suppression a reasonable prospect in the im- 
mediate future. 

In the other instance there would be no such justification 
from a public health standpoint. To make the point clear, let 
it be assumed that it had been proved that only 1 per cent, 
each of the total number of cases of typhoid, diphtheria and 
scarlet fever were due to infected milk; obviously, under such 
conditions, the expenditure of enough money and energy to 
totally eradicate milk as a source of infection, while a desir- 
able object in itself, would have a scarcely appreciable effect 
upon the general typhoid, diphtheria and scarlet fever prob- 
lem, and it is highly probable that the same amount of money 
and energy directed against other angles of the typhoid, diph- 
theria or scarlet fever problem might bring incomparably 
greater results in decreasing their prevalence. 

Because of the great practical importance of these factors 
your Board has endeavored diligently to ascertain what, if any, 
reliable data could be obtained upon this point, both within 
the Commonwealth and elsewhere. The total information ob- 
tained is exceedingly incomplete, but perhaps throws some light 
on the problem. 



140 



(1) Evidence as to the Relative Importance of Milk 
Infection in the Transmission of Certain Communi- 
cable Diseases of Man based on their Occurrence 
in Epidemics. 

It has become quite the fashion of late years among writers 
in discussing milk to remark that the importance of milk in 
connection with typhoid, scarlet fever, etc., has been until very 
recently underestimated. Your Board feels that it is perhaps 
not out of place to suggest the possibility that in the past four 
or five years at least this tendency has been reversed, and that 
to-day there is ,a strong tendency to overestimate the quanti- 
tative l relationship of milk to the prevalence of these epidemic 
diseases. 

An interesting example of this probably unconscious tendency 
is the following: In 1907 it was reported that out of a total of 
18 outbreaks of typhoid fever investigated during the two years 
immediately preceding by the Massachusetts State Board of 
Health, 14, or 77 per cent., were due to infected milk. In the 
years 1910-14 (inclusive) the same Board investigated a total 
of 86 outbreaks of typhoid, which were all that came to the 
attention of the Board, and presumably represent practically 
100 per cent, of all epidemics or outbreaks of any consequence 
occurring in the State, but found only 31, or 36.4 per cent., due 
to infected milk. Apparently, either the conditions of the milk 
supply of the Commonwealth have greatly improved in this 
respect, or two years did not cover enough time to give a fair 
average, or, as is more likely, in the earlier series too much 
emphasis was placed upon the investigation of outbreaks that 
were suspiciously indicative of milk infection from the start. 

It is very easy to pile well-proven epidemic on well-proven 
epidemic to demonstrate that milk does transmit epidemic dis- 
eases. As far back as 1908 Trask was able to collect 493 epi- 
demics of typhoid, diphtheria and scarlet fever in which the 
evidence was conclusive that the cause was infected milk. An 
enormous number of similar outbreaks have been reported since, 
ample to prove that the danger of milk transmission is serious 
and real; but epidemics do not tell the entire story. Although 
epidemics furnish the spectacular element in communicable dis- 



141 



ease work, their total percentage importance is not to be com- 
pared with that of the sporadic cases. 

Out of a total of 240 epidemics and outbreaks of typhoid, 
scarlet fever, diphtheria and septic sore throat, due to all causes, 
investigated by the State Board of Health of Massachusetts 
during the years 1910 to 1914, the total number of cases given 
by the investigators is 3,198. But in some instances no state- 
ment as to the total number can be made, and in many more 
instances a number is given with the qualification that the 
number is incomplete. Even if we assume that there actually 
were as many more cases attributable to these outbreaks as 
are given, the total number would not greatly exceed 6,000. 
But in the same years a total of 85,958 cases of these same 
diseases were reported. Since, during these years, practically 
every disease outbreak of any material proportions in the Com- 
monwealth has been the subject of a special investigation by 
the State health authorities, and not over 6,000 cases, at an 
outside estimate, can be attributed to these outbreaks, it would 
follow that the endemic prevalence of these diseases is in the 
aggregate of vastly greater public health significance than the 
more spectacular epidemic prevalence, — in this instance at 
least fourteen times as great. 

The following tabular comparisons based on Massachusetts 
investigations are of interest in this connection : — 



Summary of Epidemiological Investigations by the State Inspectors of Health 
of Massachusetts for the Five-year Period, 1910-14, inclusive, with 
Reference to Frequency of Milk Transmission. 

(1) Diphtheria. 



Year. 



Number of 
Epidemics. 



Due to 
Milk. 



Due 
to Other 

Causes. 



Percentage 
Milk-borne. 



1910, . 

1911, . 

1912, . 

1913, . 

1914, . 
Totals, 



59 



7.7 
11.0 



3.2 



142 



Summary of Epidemiological Investigations by the State Inspectors of Health 
of Massachusetts for the Five-year Period, 1910-14, inclusive, with 
Reference to Frequency of Milk Transmission — Concluded. 

(2) Septic Sore Throat. 



Year. 



Number of 
Epidemics. 



Due to 
Milk. 



Due 

to Other 
Causes. 



Percentage 
Milk-borne. 



1910, . 

1911, . 

1912, . 

1913, . 

1914, . 
Totals, 



66 



(3) Scarlet Fever. 



1910, . 

1911, . 

1912, . 

1913, . 

1914, . 
Totals, 



10 


9.0 


9 


10.0 


6 


25.0 


22 


4.3 


33 


6.0 



8.0 



(4) Typhoid Fever. 



1910, 

1911, 

1912 

1913, ... 

1914, 

Totals, .... 

Grand totals, all epidemics, 



240 



53 

194 



66.6 
18.2 
50.0 
25.8 
43.5 



38.4 
19.2 



In the above tabulation the incidence of more than one case 
in different families in the same locality at the same time is 
classed as an epidemic or an outbreak, with the natural effect 
that, with three or four exceptions, the average number of 
cases per epidemic is small. There have been many small out- 
breaks where no suspicion has been raised relative to the milk 
supply that have been handled wholly by local authorities, and 



143 

concerning which no epidemiological information is recorded in 
the State Department of Health. This fact does not invali- 
date the significance of this table, because for several years 
past it has been the fixed policy of the Department (Board) 
to investigate every case of contagious disease reported from 
a milk-producing farm, as well as every outbreak whether in 
a large or small community where milk was at all under sus- 
picion. Therefore a fuller table would only tend to lessen the 
percentage of milk-borne epidemics. 

In the same connection it is interesting to note that in the 
five years 55 other investigations were made by the State 
Health Inspectors in instances when a single case of contagious 
disease was reported from a milk-producing farm, and precau- 
tions ordered and observed, with no secondary cases of any 
nature subsequently occurring. 

In 1910 sworn testimony was given by Prof. C. E. A. Wins- 
low before the milk investigating committee of the Legislature 
(and we have found no contradictory testimony on this point) 
that in less than four years five epidemics due to milk had 
resulted in 70 cases of diphtheria, 700 cases of scarlet fever, 
and 557 cases of typhoid fever in Boston and its immediate 
vicinity. 

From a combined source of data (consisting of (a) replies to 
a questionnaire sent to the local boards of health and (6) an 
analysis of the investigations of outbreaks of infectious diseases 
made by the State Inspectors of Health) in Greater Boston, 
there can reasonably be attributed to infected milk during the 
six-year period, 1909-14 (inclusive), 6 cases of diphtheria, 845 
cases of scarlet fever, 1,000+ cases of septic sore throat and 
365 cases of typhoid. Thus, in five epidemics occurring between 
January, 1907, and July, 1910, 1,397 cases of milk-borne infec- 
tious diseases occurred in Greater Boston, while in the same 
locality in the six-year period, 1909-14 (inclusive), from all 
available sources, 2,210+ cases of typhoid, scarlet fever and 
septic sore throat have been traced to milk. 

When it is recalled that by far the greater portion of Greater 
Boston's milk supply is from pasteurized sources, and that all 
these cases proved to have been due to comparatively small 
raw milk supplies, the seriousness of the milk problem, as it 



144 

pertains to the occurrence of the diseases in question, cannot be 
denied or ignored. 

At one time we contemplated making a similar analysis for 
the same period of the milk-borne epidemics in comparison with 
the total number of epidemics of these same diseases reported 
by those States having the most complete communicable dis- 
ease reporting systems. Correspondence with the epidemiolo- 
gists of various States indicated that such data were not in 
readily available form in any of them, and distance and lack 
of time have prevented us going any further into this most 
interesting and suggestive line of investigation. 

A' careful, although by no means exhaustive, search of English 
references throws no light upon the subject, although we rather 
suspect that such data may be available. We have made no 
examinations in reference to this point into Scandinavian con- 
tributions to the milk question, and consider that any search 
into the data available from other European countries, aside 
from Great Britain and Scandinavia, would be time wasted 
because of (a) the widespread use of goat's milk in many parts 
of the continent milked in containers furnished by the con- 
sumers at the consumer's door, and (b) an almost universal 
European practice of boiling the milk as a sanitary precaution. 

(2) Evidence as to the Total Relative Importance of 
Milk Infection in the Transmission of Certain Com- 
municable Diseases of Man based on their Occur- 
rence in Endemic or Sporadic Form as well as in 
Epidemics. 

Although diligently sought, practically no authoritative data, 
in our opinion, can be obtained at present upon this important 
point. Moreover, such statements, generalizations, inferences 
and hypotheses as are found in milk literature bearing on this 
subject are not only resting on far from conclusive epidemio- 
logical foundations, but are in many instances rather contrary 
to such fragmentary epidemiological evidence as we have been 
able to uncover. 

It is easy to see that the temptation to make out the case 
against milk as strong and startling as possible, buttressed by 



145 

the spectacular corroborative evidence of the milk-borne epi- 
demic, has had a tendency to produce these sweeping state- 
ments and charges in regard to milk infection. 

It is an interesting reflection upon the inadequate develop- 
ment of practical disease-preventive measures in this country 
to note that the routine machinery of no State and of but few 
city health departments is at the present time developed to 
such a comparatively modest degree of efficiency as will enable 
them to make routine investigations into the reported cases of 
these diseases, known to be at times milk borne, sufficient to 
bring out whether or not milk should be considered as a certain 
or probable source of infection in any given case or group of 
cases. 

In the course of its investigations this Board has made a 
careful and, we believe, a fairly representative study of the 
best available modern milk literature, with special reference to 
its bearing upon infectious diseases, infant mortality and the 
gastroenteritides of children. 

We have been forcibly struck with the casual, elusive and 
vague character of statements which continually recur relative 
to the proportional significance of infected milk to these dis- 
ease conditions. 

The literature of milk, when it comes down to this concrete 
problem, either admits the total inadequacy of present data 
on the relative significance of milk infection in disease trans- 
mission, or is discreetly silent, or more often takes refuge in 
indefinite and elusive generalizations. 

In attempting to arrive at some conclusions in this matter 
the following sources of evidence have been carefully con- 
sidered: — 

(a) Replies to a questionnaire sent to Massachusetts cities 
and towns. 

(6) Written and verbal statements of the epidemiological 
authorities of various States. 

(c) The reports 'of the special typhoid board of the United 
States Public Health and Marine Hospital service in the Dis- 
trict of Columbia (1906-10). 

.(d) The evidence of the records of the Boston City Health 



146 

Department supplemented by the evidence of the records of 
certain other Massachusetts cities. 

(e) Epidemiological resumes of the New York City Health 
Department, with special reference to milk, including the resid- 
ual typhoid theory, by Dr. M. L. Ogan of the New York City 
Health Department. 

(/) "Milk and its Relation to the Public Health" (United 
States Public Health and Marine Hospital Service, Hygienic 
Laboratory Bulletins Nos. 41 and 56). 

(g) Miscellaneous works on milk, or incidental references to 
milk in connection with communicable disease by American and 
foreign authorities other than above (practically all English). 

(a) Replies to a Questionnaire sent to Massachusetts Cities and 

Towns. 

Owing to the fact that Massachusetts local boards of health 
are required by law to report to the State health authorities 
only the names, addresses, diagnoses and dates upon which 
cases of infectious diseases are reported to them, and that the 
routine notifications to the State Health Department are limited 
strictly to this information, the records of the Massachusetts 
State Health Department throw no light whatever upon the 
question under discussion. Thinking that a statement cover- 
ing the entire State, based on the records of the local boards 
of health, would throw some light on the problem, your Board 
prepared and sent out in July of this year a circular question- 
naire to all of the local boards of health in the Commonwealth. 
Owing to very incomplete replies a second letter, explaining a 
little more in detail the purposes of the inquiry, was sent to 
those cities and towns that had failed to reply in July. (See 
Appendix B.) 

The form ,of the questionnaire was extremely simple. A 
statement was requested of the total number of cases of typhoid 
fever, diphtheria, scarlet fever and septic sore throat reported 
to the local board during the five-year period, 1909-13; of the 
number recorded as due to milk infection following investiga- 
tion by the local board; the number suspected of being milk 
borne without conclusive evidence being obtained; the total 
number of deaths from the same diseases in the correspond- 



147 

ing period, and the number of such deaths attributed to milk 
infection. 

When we consider the widespread interest relative to the 
connection between the milk supply and the public health that 
has prevailed in this Commonwealth for some years past, and 
the amount of public agitation that has arisen in relation 
thereto, it must be confessed that the total returns from this 
questionnaire were somewhat disappointing. It was sent out 
merely as a means of obtaining the facts relative to milk and 
communicable disease prevalence, and of supplying information 
that the State health authorities had no other means of pro- 
curing, and we had mistakenly anticipated a very complete 
response. However, whether from procrastination, thoughtless- 
ness or a deliberate intent not to co-operate in this matter, one 
city and 156 towns, representing in all a population of 556,554, 
or about 16 per cent, of the total population (Census 1910), 
failed to make any reply or acknowledge receipt of the two 
requests up to date. 

Of the entire group of cities and towns replying, 34 cities 
and 162 towns, respectively, representing a population of 
2,809,862 (Census 1910), or 84 per cent, of the State, the 
greater majority replied in full. A number of the smaller 
towns, however, simply replied "no records." We have been 
somewhat in doubt whether to interpret this reply as meaning 
that these boards of health actually kept no records of com- 
municable diseases, or whether it meant that in the period 
covered no cases of the diseases concerning which information 
was sought had been reported. 

Forty towns, having an aggregate population of 50,134, state 
that no cases of these diseases due to any causes have been 
reported in this period to their local boards of health. Inas- 
much as the "no record" towns and "no cases" towns are all 
comparatively small, it may be reasonably inferred that at 
least no outbreak of these diseases could have occurred in any 
of them during the period under inquiry, for such an occur- 
rence would have been practically certain to have become a 
matter of record in the local board of health office. It is also 
true that in .practically all of these towns the machinery of 
milk production and distribution is extremely simple. 



148 



The remaining 102 towns and the 34 cities — answering the 
questionnaire represent a total population of 2,703,759. They 
report as follows : — 



Diseases. 



Total Num- 
ber of Cases, 
1909-13. 



Cases due 
to Milk. 



Cases Milk 
suspected. 1 



Typhoid fever, 
Diphtheria, 
Scarlet fever, . 
Septic sore throat, 
Totals, 



11,282 
31,866 
31,012 
2,436 



76,596 



553 

11 

495 

1,914 



2,973 



135 
49 

57 



241 



Diseases. 



Total Num- 
ber of Deaths, 
1909-13. 



Deaths due 
to Milk. 



Deaths Milk 
suspected. 1 



Typhoid fever, 
Diphtheria, 
Scarlet fever, 
Septic sore throat, 
Totals, 



1,425 

2,580 

991 

49 



5,045 



Analysis of these totals demonstrates that in only 0.03 per 
cent, of cases has the transmission of diphtheria been definitely 
assigned to infected milk, and in only .19 per cent, was milk 
either proven or suspected; 1.6 per cent, of the reported cases 
of scarlet fever have been definitely attributed to milk infec- 
tion, and 1.8 per cent, proven or suspected; in 79 per cent, of 
the cases of septic sore throat (not reportable until 1914) milk 
was assigned as the cause; in 5 per cent, of the cases of 
typhoid milk was definitely assigned as the cause, and in 6 
per cent, milk was either proven or suspected to be the agent 
of infection in this disease. Taking all of these diseases in 
a group, 3.9 per cent, were definitely attributed to milk, and 
in 4 per cent, of all the cases milk was proven or suspected. 
Considering mortality, 3 per cent, of typhoid deaths are possibly 
attributable to milk, 0.08 per cent, of diphtheria deaths, 0.8 per 
cent, scarlet fever deaths, 98 per cent, septic sore throat deaths; 
an average for the whole group of 2 per cent. of. the deaths 
may be attributed to infected milk. 



1 "Suspected" here means that milk was considered to be the probable source of infection, 
but was not conclusively proven. 



149 



(6) Written and Verbal Statements of the Epidemiological Author- 
ities of Various States. 
Specific information upon the point under discussion, i.e., the 
endemic prevalence of milk infections, was sought from the 
epidemiological authorities of the States of New York, New 
Jersey, Pennsylvania, Maryland, Minnesota and Kansas. (See 
Appendix D.) These States were selected because they, and, 
as far as we are aware, they only among the several States, 
have communicable disease reporting systems analogous to the 
Massachusetts system. In fact, the morbidity reporting sys- 
tems of these States, which place in the hands of the State 
health authorities the individual case reports of communicable 
diseases; are supposed to furnish more direct epidemiological 
data than does the Massachusetts system. But, as was the 
experience in relation to the epidemic prevalence of milk-borne 
infections, none of these States was in a position to furnish 
even roughly approximate quantitative returns. A resume of 
the replies follows: — 

Kansas (correspondence only). - Reported only two epidemics trace- 
able to milk on record, but stated that othere have occurred. Could fur- 
nish nothing as to endemic frequency of milk infection. 

New Jersey (correspondence only) . — Furnished nothing on endemic 
frequency of milk infection. Referred to several interesting milk-borne 
epidemics. 

Pennsylvania. — No reply. 

Maryland (correspondence and verbal) (See Appendix) . — Furnished 
no data relative to the endemic factor of milk in their diseases. Stated 
that they have had eight outbreaks of typhoid, aggregating 390 cases, 
which were milk borne, from 1884 to date, and one of septic sore throat 
in 1912 involving somewhere between 1,000 and 3,000 cases. 

New York (correspondence and verbal) . — Gave some interesting 
epidemics, some of considerable extent, of all the diseases under con- 
sideration. Stated that as yet no analysis of endemic prevalence had been 
made by examining either the records of local boards of health, or by 
analysis of the original reports received from physicians on file in the 
Communicable Disease Division of the State Health Department, but 
expressed an opinion that such a study might be profitably made. 

Minnesota (correspondence and verbal) (See Appendix) . — The exact 
language used in replying to our letter of inquiry by the director of the 
Division of Preventable Diseases of the Minnesota Board of Health is 
as follows: — 



150 

In endeavoring to comply with, your request regarding instances in which milk 
has been implicated in the transmission of scarlet fever, diphtheria and typhoid 
fever I am somewhat disappointed. Dr. Greene was kind enough to go through 
the records of the division very carefully from Aug. 1, 1909, to date. He made a 
card index of reports where it seemed that milk might have been a factor in the 
spread of infection. I have personally gone through all these reports. While many 
of them indicate that milk was a factor to some extent in the spread of disease, only 
in a few was milk the chief route of infection, or definitely proven to be even an 
active factor. I may say that in several epidemics which I personally investigated 
there was strong circumstantial evidence indicating that milk was the main route 
of infection. However, careful investigation proved that appearances were de- 
ceiving, for it was readily shown that the milk could not have been infected, and 
the cases suspected to be milk infections were traced to direct contact with known 
cases at a time which would fully account for the infection. 

In addition, reference was made to a considerable number of 
true milk-borne epidemics, including one of typhoid which was 
due to butter, another, also typhoid, due to both milk and 
cheese, and five other milk-borne typhoid outbreaks, two diph- 
theria outbreaks, one each from milk and butter, and one definite 
and three doubtful milk outbreaks of scarlet fever. In personal 
interviews the director of the Minnesota Division of Preventable 
Diseases expressed a strong skepticism as to the comparative 
frequency of milk infection in both sporadic and epidemic cases 
of these diseases. 

(c) The Reports of the Special Typhoid Board of the United 
States Public Health and Marine Hospital Service on. the 
Origin and Prevalence of Typhoid Fever in the District of 
Columbia (1906-09). 

Although these reports deal exclusively with typhoid, yet 
they have a very great significance because of the exceptional 
thoroughness with which the epidemiological studies were made, 
their continuance through a series of years (four), sufficient to 
offset to some degree the exceptional factors of any single year, 
and the fact that the results of this study have in a general 
way passed current for several years among American sani- 
tarians as an approximately correct index to the relative im- 
portance of milk infection to the spread of typhoid. In trying 
to arrive at a fair and just appreciation of the significance of 
their results, three facts need to be borne in mind. 

1. That the total number of milk-borne cases of typhoid re- 
ported upon in this series are explicitly stated to be all cases 
occurring under epidemic conditions; in fact, to have been due 



151 

to six well-defined epidemics. It is striking that such a small 
number of localized milk-borne typhoid outbreaks should have 
produced so high a percentage of the local typhoid. 

2. That while the percentage of cases, attributed to milk 
transmission, for the first three years are all approximately 10 
per cent., the fourth year the percentage drops abruptly to 2.2 
per cent. 

3. That the great proportion of cases unaccounted for may 
or may not have contained a considerable number of cases in * 
which the infection was milk borne. If so, and if the milk epi- 
demics occurring in the three earlier years represent a fair average 
of the relative frequency with which milk-borne infections occur, 
the relative importance of milk-borne infection in typhoid is 
high. If the contrary be true, its relative significance com- 
pared to contact, or water, is perhaps quite small. 

Although these studies relate to District of Columbia con- 
ditions exclusively, the conclusion is unescapable, although they 
nowhere definitely express such an opinion, that these investi- 
gators are strong adherents of the view that milk is a very 
great factor, relatively speaking, in the transmission of Ameri- 
can urban typhoid. We particularly value their evidence be- 
cause it rests on a basis of careful epidemiological work, and 
is, together with Ogan's New York City work, the only evi- 
dence we have found that is at all reliable pointing towards a 
substantiation of the relatively high milk factor that has been 
so commonly, not to say recklessly, assumed by so many 
authorities. 

The unqualified fashion in which these investigators commit 
themselves to this "high milk-borne percentage" theory of 
typhoid transmission can be clearly seen by the following 
statements: — 

Since so many cases occurred in the course of definite and readily 
recognizable milk outbreaks, it is almost certain that a number of scattering 
cases, probably aggregating more than the number definitely attributable to 
milk-borne infection, resulted from milk-borne infection. 

And again: — 

In each of the four years the cases attributed to milk-borne infection 
comprised only the cases which occurred in the course of pronounced 



152 

outbreaks among the customers of certain dairymen. In view of the 
way in which the bulk of the milk consumed in Washington is handled, 
it may be logically surmised that the proportions of cases caused by milk- 
borne infection were considerably larger than the figures in the summary 
indicate. 

Whether the Washington experience can be assumed as fairly 
typical for American cities is another question. It is interest- 
ing to note that although these investigators, reporting on a 
population of approximately one-third of a million, found six 
distinct milk-borne outbreaks in a space of four consecutive 
years, the Maryland State Board of Health, reporting for a 
population approximately a million greater, only recorded a 
total of eight milk-borne typhoid outbreaks in thirty-one years. 
Since Maryland all but surrounds the city of Washington, cli- 
matic, social and racial factors are fairly comparable, and even 
though it be conceded that a great many outbreaks have been 
overlooked by the Maryland authorities, as is undoubtedly the 
case, yet it at once raises the question as to whether the three 
years 1906, 1907, 1908 may not have represented unusually 
high years for milk-borne typhoid outbreaks in Washington. 

The investigators apparently unhesitatingly assume that the 
low percentage of infection definitely attributable to milk dur- 
ing 1909 (2.2 per cent, in contrast to the average of 10 per 
cent, so accounted for during the three years previous) can be 
explained entirely by improvement in the milk supply, or, to 
quote their own words: "The number of cases definitely at- 
tributable to milk-borne infection was considerably smaller in 
1909 than in any of the three previous years, and it appears 
quite probable that the decrease in the typhoid rate in Wash- 
ington since 1906 has been due in part to the improvement in 
the city's milk supply from year to year." 

No data are given to indicate upon what ground the state- 
ment relative to the improvement in the city's milk supply is 
based, but inasmuch as the percentages of the milk-borne cases 
for 1906, 1907, 1908 are remarkably even, and the 1908 per- 
centage exceeds, although only by a fraction, that of 1907, it 
is a little difficult to deduce from this just where the improve- 
ment "from year to year" was manifesting itself in such a 
fashion as to explain the 75 per cent, "frequency drop" of 



153 

1909, and we respectfully suggest that these consecutive "high 
percentages" years may have been of themselves an anomaly. 

Every analysis of the six outbreaks listed by these in- 
vestigators discloses several interesting facts. In • 1908 one 
distinct outbreak is recorded involving 52 cases. This out- 
break was followed up, the carrier detected, typhoid bacilli iso- 
lated from her feces, sale of milk from her premises stopped, 
and the outbreak abruptly terminated. This outbreak cer- 
tainly fulfilled the most exacting epidemiological requirements 
of proof. 

In 1909 the single outbreak attributed to milk failed of con- 
firmation by application of laboratory methods for detection 
of carriers to all who had to do with the milk, although the 
circumstantial epidemiological evidence was very strong. 

In the other four epidemics, so far as the evidence appears, 
the only basis for classifying these groups of typhoid fever as 
distinct milk outbreaks was the suspicious frequency of the 
occurrence of typhoid cases upon the routes of certain dealers. 

We admit that this reasoning is plausible, but in the absence 
of any statement as to past epidemiological history of milk 
producers on the farms an& the dairy employees distributing 
these milks, and in the absence of any laboratory confirmative 
work, we consider that the conclusions do not rest upon suf- 
ficiently sound epidemiological proofs to consider them as fairly 
attributable. 

Therefore, in all, we find but one of these six outbreaks com- 
pletely proved (the carrier case in 1908). The other five out- 
breaks, which the authors consider as positive outbreaks, all 
present gaps in evidence of more or less serious nature. 

Another extremely interesting observation by the authors is 
the following: In the last year reported they state that 4 
dairymen, all doing a relatively large business, were that year 
pasteurizing their milk, and they make the observation that 
1 of them had practiced pasteurization for the whole period 
(four years); 2 only began in the middle of 1908; and 1, July 
1, 1909. They present a table showing that the number of 
cases on these three dealers' routes per 100,000 gallons of milk 
distributed had shown a sharp decline since inaugurating pas- 
teurization. This argument is rather weak, in our opinion, for 



154 



the periods both before and after pasteurization are too short 
to justify any deductions as to the cause and effect connection 
between pasteurization and typhoid incidence, although in the 
case of the dealer who pasteurized throughout, and consistently 
had low incidence per 100,000 gallons, the argument may be 
given some weight. 

The rates of typhoid incidence per 100,000 gallons of milk 
distributed, given year by year for the three dealers, are as 
follows (the heavy-faced figures indicate time when pasteuriza- 
tion began) : — 



No. 3. 



No. 4. 



No. 8. 



1906, 
1907, 
1908, 
1909, 



16.6 
7.1 
5.8 
1.4 



52.5 
21.6 

10.1 
7.0 



35.6 
17.1 
18.8 



It is possible to pick three other dealers, also selling large 
amounts, who never pasteurized, and show the same striking 
tabular drops; for example: — 



No. 2. 



No. 5. 



No. 7. 



1906, 
1907, 
1908, 
1909, 



21.5 
23.4 
10.2 
4.2 



23.7 
15.6 
13.3 
8.0 



35.0 
13.6 
9.1 

7.8 



The investigators seem to believe that their pasteurization 
showing is strong corroborative proof of milk infection being 
a very important factor in the transmission of typhoid. If all 
four of the dealers who pasteurized their product in 1909 are con- 
sidered in a group, their total output is 799,000 gallons of pas- 
teurized milk. They also had a total of 39 cases of typhoid 
on their routes. Presumably the majority of these, at least, 
would be considered as due to other causes than milk by the 
investigators. But if the 16 other dealers, whose total gallon 
outputs are similarly given, are considered as one group, an 



155 

interesting comparison ensues. In this group there is a total 
output of 1,514,000 gallons of unpasteurized milk, and there 
occurred 98 cases of typhoid on their routes. However, among 
them is the one very small dealer (putting out only 7,000 gal- 
lons in the period) on whose rpute occurred the outbreak of 13 
cases, which have been considered by the investigators as un- 
questionably milk borne. Deducting these, it leaves a total 
of 85 cases to 1,507,000 gallons of milk distributed. But the 
ratios of 39 to 799,000 and 85 to 1,507,000 are substantially the 
same. • 

We would not have our exceptions to their pasteurization 
argument interpreted as meaning that we are skeptical as to 
the value of efficient pasteurization as an agency in controlling 
disease transmission through milk. We merely wish to point 
out that, so far as the Washington typhoid series are concerned, 
pasteurization was not applied long enough or generally enough 
to fairly attribute typhoid reduction to its influence. This 
mathematical comparison leaves the arguments of the inves- 
tigators, in which they give the impression that milk infection 
is a major although undeterminable factor in the spread of 
the Washington typhoid of unattributed causation, rather up 
in the air. For it is quite evident that they are citing the 
progressive decline in the number of cases per 100,000 gallons 
of milk distributed on. the routes of the dairymen practicing 
pasteurization, after the institution of the practice, as inferen- 
tial evidence that milk infection played a large part in the 
transmission of typhoid on their routes before they began pas- 
teurization. 

(d) The Evidence of the Records of the Boston City Health De- 
partment supplemented by the Evidence of the Records of 
Certain Other Massachusetts Cities. 
It is a source of regret to your Board that we did not earlier 
realize the great possibilities of a more extensive quantitative 
analysis of the records of communicable diseases of the large 
cities of the country having well-equipped health departments, 
in reference to the question of the frequency of milk transmis- 
sion of disease. To make this study of most value, the precise 
methods followed as to epidemiological and laboratory proce- 



156 

dure by each city would need to be clearly known, the relative 
efficiency of reporting by physicians, the proportion of certified 
and pasteurized milk used and periods when introduced, and 
above all, the basis upon which each department made its 
routine classification as the channels of transmission. Studies 
among cities of under 100,000 would not be of the same rela- 
tive weight, because the total series could not be sufficiently 
large to safely draw true relative deductions. 

But we believe that carefully analyzed returns from city 
health departments of such standards as those of Boston, Provi- 
dence, Baltimore, New York, Chicago, Seattle, and many others 
where careful epidemiological and laboratory work is carried 
out on every communicable disease case as a routine, would 
throw a great deal of light upon this very dark subject. 

Because of the fact that the records of the Boston City 
Health Department have been immediately accessible to your 
Board, we have had opportunity to appraise carefully the 
methods of procedure upon which these classifications rest, and 
the more we have gone into this subject, through conference 
with the authorities of the Boston Health Department, the 
more we have been impressed with the thoroughness and relia- 
bility of their routine investigations of communicable diseases 
as regards the demonstrable or probable sources of infection. 
On these grounds, on account of the large aggregate number of 
cases and the very evident high degree of co-operation on the 
part of the practicing physicians of the city in reporting and 
suggesting epidemiological clues to the health officials, we place 
a very high degree of confidence in their returns. 

According to the data furnished us by the Division of Com- 
municable Diseases of the Boston City Health Department, out 
of a grand total of 23,336 cases of typhoid, diphtheria, scarlet 
fever and septic sore throat, recorded by the Department in 
the five-year period, 1909-13, inclusive, only 1,132 cases have 
been attributed to milk-borne infection, following careful epi- 
demiological investigations of each individual case. In Boston the 
physicians practically never report a case of streptococcic throat 
infection as "septic sore throat," except in the presence of a 
milk-borne epidemic. Therefore the percentage of septic sore 
throat among the milk-borne diseases is practically 100 per 
cent. When this disease is excluded the relative proportions 



157 



are: total diphtheria, scarlet fever and typhoid cases, 22,536; 
total cases of same diseases attributed to milk, 332. This gives 
milk a total percentage importance among the total channels 
of infection for these diseases for the city of Boston, for five 
years, of approximately 1.5 per cent. If septic sore throat is 
included, the total percentage of cases due to infected milk for 
the entire group of the four diseases rises to approximately 
5 per cent. 

The most interesting point of all in connection with the 
Boston experience is that all of these cases occurred in non- 
pasteurized milk supplies. However, the number of dealers in- 
volved in these non-pasteurized supplies are about 250, or 83 
per cent, of the total number of dealers. 

The percentage of pasteurized supply to the total supply 
has considerably increased during the five years. The B°ston 
Health Department estimates the percentage of pasteurized 
milk (including cream) in these years to be as follows: — 



Per Cent. 



Gallons sold 
Yearly. 



1909, 
1910, 
1911, 
1912, 
1913, 

Average, 



30.68 
49.90 
73.62 
70.59 
80.63 



62.63 



22,297,722 
23,150,125 
24,170,026 
24,745,423 
27,635,785 



24,499,785 



The Boston authorities feel, and with good epidemiological 
basis, that the extension of pasteurization has been a most 
efficacious safeguard against the possible more extensive trans- 
mission of outbreaks of the diseases under consideration through 
milk. 

But apparently, just as in the case of the Washington, D. C, 
typhoid series, it is scarcely justifiable to conclude that there 
would of necessity have been a much greater occurrence of milk- 
borne diseases in the city if the milk had not been so generally 
pasteurized than actually was the case. 

Seven other of the larger cities of Massachusetts — Fall 
River, Pittsfield, Brockton, Lowell, New Bedford, Springfield 
and Worcester — had in 1910 an aggregate population of 



158 

646,152. This population is fairly comparable to the popula- 
tion of Boston in 1910, — 670,586. But only two of these — 
Springfield and Worcester — have at present a considerable 
percentage of milk pasteurized. Springfield has 38 per cent, 
pasteurized; Worcester, 30 per cent.; Fall River, 14 per cent.; 
Brockton, 8 per cent.; Lowell, 7 per .cent.; Pittsfield, per 
cent. New Bedford states that practically none of the milk 
supply of that city is pasteurized. This gives an average pas- 
teurization of 19.5 per cent, for this group. 

The total number of diphtheria cases returned during the 
same five-year period as definitely or possibly due to milk in- 
fection for this group of cities is 0; of septic sore throat, 0; of 
scarlet fever, 0; and of typhoid, 280. The total number of 
cases of diphtheria, scarlet fever, septic sore throat and typhoid 
returned by this group for the same period is 16,948. This 
gives a percentage of milk-borne cases of these diseases (in this 
sefies, all typhoid), for the five-year period for these cities, of 
1.(5 per cent., the same as the Boston percentage for five years 
(omitting the septic sore throat cases) of 1.5 per cent. 

Such results as these were not in the least anticipated when 
we began this quantitative study. We confess to surprise, even 
astonishment at reaching quantitative results so far apart from 
those generally current as to the relative frequency of milk 
infection. What can such results mean? Do they mean that 
milk outbreaks have been overlooked right and left by these 
city departments? Very possible, but not probable. All of 
these departments are considered efficient. If pasteurization 
is as important as we have always been led to believe in stop- 
ping the incidence of milk-borne infection, and if milk-borne 
infections are anywhere nearly as frequent an occurrence in 
non-supervised milk supplies as has been practically universally 
assumed for years, then the relative percentage of milk-borne 
infections in these cities from unmistakable outbreaks ought to 
be materially higher than the percentage of Boston's milk-borne 
outbreaks, due in every instance to that city's relatively small 
raw milk supply. 

These points are suggestive : — 

First. — It is rather surprising to find that these 7 cities, 
whose aggregate population is only slightly less than that of 
Boston, report only about three-fourths as many cases of the 



159 

diseases under consideration from all causes. Whether this 
means less efficient reporting by the physicians of these cities, 
or an actual lower frequency of occurrence of these diseases 
than in Boston, we are unable to determine accurately, but 
we believe the latter rather than the former factor is princi- 
pally concerned. 

Second. — If milk were in reality a considerable factor in 
the causation of sporadic cases of these diseases there should 
be a reflection of this effect in an increase of the general fre- 
quency rate of these diseases, — the exact antithesis of what 
is found. 

Third. — Another possible explanation of this discrepancy in 
the comparative frequency of incidence of diphtheria, scarlet 
fever and typhoid in this group of cities, when contrasted with 
Boston, may be their smaller concentration of mass of popu- 
lation, with its concomitant lessened opportunities for contact 
infection. 

Fourth. — For the most part the milk supply of these cities 
is subject to the "short haul." Just what relation this may 
possibly have in reference to the transmission of communicable 
diseases it is difficult to state, especially as all the dairies im- 
plicated in the Boston series are also "short haul" dairies. 

Fifth. — Nearly two-thirds of all the cases returned as due 
to milk infection in this group are attributable to one carefully 
demonstrated typhoid milk infection from a urinary carrier. 

This again rather suggests that milk-borne typhoid, scarlet 
fever and diphtheria are possibly essentially epidemic rather 
than sporadic in nature; that possibly they occur only when 
a certain complete chain of circumstances in reference to the 
carrier or infected person and milk exists, permitting a rather 
massive infection of the milk; and that these circumstances 
do not occur nearly as often, in the aggregate, as we have 
been led to believe from the spectacular and striking character 
of the results when such infections do take place. 

(e) The Residual Typhoid Theory of Ogan. 
Probably no other city in the country makes as careful a 
study of its communicable diseases from the standpoint of epi- 
demiology as New York. Dr. M. L. Ogan, chief of the Division 
of Epidemiology of that Department, has made some interest- 



160 

ing and suggestive studies as to the possible milk factor in the 
transmission of typhoid in that city. 

His results are particularly interesting, as he comes to the 
conclusion that probably 30 per cent, of the endemic typhoid 
in 1912 — the last year before pasteurization became practi- 
cally universal in New York — was due to infection through 
milk. To abstract his own words, this conclusion was arrived 
at by noting that one large company supplying 325,000 people, 
or 12 per cent, of the population of Manhattan borough, had 
among its patrons, using its milk exclusively, 111 cases of 
typhoid in 1912. At this ratio the whole population, had it 
used this milk exclusively, should have had only 839 cases, 
assuming that pasteurized milk could not transmit typhoid; 
but from the whole population 1,184 cases were reported for 
the year, hence there is left a residue of 345 cases, or 30 per 
cent, of the whole, which according to this method of reasoning 
(italics ours) are due to milk. The author then adds another 
9 per cent, which was attributed — on good epidemiological 
grounds, we assume, although the method or basis of classifi- 
cation is not given — to milk-borne^ epidemics, and concludes 
that it is not unreasonable to attribute a total of 39 per cent, 
of the borough's typhoid of that year to milk (30 per cent, 
endemic plus 9 per cent, epidemic). He then admits that other 
factors might have had an effect in the reduction of typhoid 
between 1911 and 1914 which is in all 53 per cent., mentioning 
better oyster supply, better water supply, more stringent food 
handling sanitary regulations, and advance in sanitary intelli- 
gence on the part of the general public. He also states that 
this method of computing the residual milk factor in typhoid 
is open to some criticism, and in this last we are forced to 
agree with him. 

In brief, while we cannot but admire the ingenuity of his 
reasoning, and have the deepest respect for the painstaking 
epidemiological and laboratory work that lies back of it, we 
cannot see that his conclusions are justifiable; too many other 
possible factors still remain unexcluded. 



161 



(/) "Milk and its Relationship to the Public Health" (Bulletins 
No. 4.1 and 56 of the Hygienic Laboratory, United States 
Public Health and Marine Hospital Service, 1908). 

This- report has a rather unique claim to authority among 
the contributions to the literature of milk. It represents the 
final joint conclusions of the medical and agricultural experts 
of the Federal government upon this subject, based on pains- 
taking studies and researches of their own, as well as careful 
and exhaustive reviews of the results of other workers through- 
out the world. It may be safely rated as one of the most, if 
not the most, painstaking investigations into the subject ever 
known. It fills a bulky volume of over 800 pages. 

Nevertheless, in searching carefully through it for information 
as to the quantitative relation between infected milk and the 
transmission of infectious diseases, the nearest to a definite 
statement that we can find is the following rather cryptic sen- 
tence by Eager. He says: "The effect of milk epidemics on 
morbidity and mortality returns may be surmised by the fre- 
quency with which such epidemics occur." 

Such statements as these are simply concealing our ignorance 
of this subject, our utter lack of reliable knowledge, by impres- 
sive sounding phrases that get us nowhere. Moreover, if Mas- 
sachusetts' experience is in the slightest degree reliable, the 
prevalence of these diseases in epidemics due to all causes 
bears but a minor percentage relation to their total occur- 
rence, and, among epidemics, only a minor percentage can be 
justly attributed to milk. 

(g) General Literature of Milk (American and Foreign). 

We have studied carefully, though by no means exhaustively, 
American and English authorities for definite statements based 
on sound epidemiological studies relative to the comparative 
importance of milk transmission in the spread of those com- 
municable diseases of man which are transmitted at times 
through the medium of infected milk. The general consensus 
of expert opinion relative to tuberculosis and milk has already 
been covered. 

In studying the general literature of milk and the literature 



162 

of epidemiology in respect to its incidental discussions of milk 
transmission of diseases, especially in reference to the great 
trio of epidemic diseases that are universally conceded to be 
at times milk borne, — i.e., diphtheria, scarlet fever and ty- 
phoid, — statements continually recur of which the best that 
can be -said is that they shade from the frankly negative, or 
the evidently purposely vague, to the entirely hypothetical in 
reference to this important problem. 

As we have repeatedly pointed out, the striking spectacular 
evidence is always that of the milk-borne, or alleged milk- 
borne, epidemic, and this type has been given the entire atten- 
tion of the authorities that we have consulted, with one notable 
and authoritative exception, — Chapin. When some incidental 
reference is made to the problem of the relative significance of 
milk infection, about the only surmises hazarded are in refer- 
ence to typhoid. Three in particular have struck our attention 
forcibly from the widespread manner in which they are quoted 
as a basis for judgment. One is the now classical report by 
Harrington, in reference to 14 out of a total of 18 typhoid out- 
breaks in Massachusetts being due to milk. Another is the 
assumed 10 per cent, factor of milk infection in typhoid trans- 
mission of the Typhoid Board of the United States Public 
Health and Marine Hospital Service for the District of Colum- 
bia. We have already discussed the fairness of these two con- 
clusions in detail. A third reference is worthy of special notice, 
as it has been quoted quite as widely as the other two, and be- 
cause it may be fairly cited as a typical example of the sweep- 
ing generalizations as to the dangers of milk that can be found 
in many quarters. We refer to Whipple's well-known work on 
"Typhoid Fever." Another reason why we feel it is particu- 
larly worthy of citation is because the eminent author frankly 
admits that the assertion rests on no solid epidemiological basis, 
and because in justice to him it should be noted that in an- 
other chapter of the same work, devoted exclusively to the 
effect of milk supplies upon typhoid rates of cities, he par- 
ticularly gives this wise caution in reference to the matter: 
"... the data for a fair discussion of this subject have not 
yet been collected." We have never found this statement 
quoted. 



163 

But very casually on another page in the chapter devoted to 
the distribution of typhoid he makes this incautious statement 
which we have found quoted, apparently with approbation, in 
numerous places: "In a general sort of way it may be said 
that in the cities of the United States at the present time 
about 40 per cent, of the typhoid fever is due to water, 25 per 
cent, to milk, 30 per cent, to ordinary contagion (including fly 
transmission), and about 5 per cent, to all other causes." 

The one good authority who challenges the fairness and ac- 
curacy of these assertions as to the high percentage importance 
of milk infection in the transmission of diphtheria, scarlet fever 
and typhoid is Chapin of Providence. In his work on "The 
Sources and Modes of Infection" he says: — 

It will be noted that though scores of outbreaks of typhoid fever may 
occur each year, they do not include more than a small fraction of the 
total typhoid fever. It may be claimed that only a small proportion of the 
milk-borne outbreaks are recognized as such, but I cannot think that 
this is so in the English cities and the better class of American cities. . . .. 
We can hardly believe that milk outbreaks could have, except rarely, 
escaped detection in the English cities, or in such cities as Boston, Worces- 
ter, Springfield, Rochester, Baltimore, Philadelphia and New York. 

The importance and value of the reports on typhoid fever in Washing- 
ton have, as it appears, given a rather exaggerated importance to the 
danger from milk. That there was a certain amount of typhoid fever 
in Washington, due to milk, during the three years in question, is no 
reason for assuming a similar percentage of milk-borne typhoid fever for 
the other cities of the country. Trask was able to find during the years 
1903-07 about 1,900 cases in the United States traced to milk. During 
this period there were in the registration area 57,023 deaths, and the 
total number in the whole country must have been at least double, or 
114,000.' The fatality is probably not over 10 per cent., so that there 
must have been at least 1,000,000 cases. Nineteen hundred is 0.19 per 
cent., which is very different from the 10 per cent, now commonly assumed 
as due to milk. I do not of course believe that all the milk outbreaks 
were reported, but the number would have to be increased -fiftyf old to 
equal 10 per cent., and it can scarcely be believed that 98 per cent, of all 
milk outbreaks fail of recognition. 

In reference to diphtheria and scarlet fever transmission by 
milk, he further states : — 

Scarlet fever and diphtheria are certainly much more rarely trans- 
mitted by means of milk than is typhoid fever. Although the percentage 



162 

of epidemiology in respect to its incidental discussions of milk 
transmission of diseases, especially in reference to the great 
trio of epidemic diseases that are universally conceded to be 
at times milk borne, — i.e., diphtheria, scarlet fever and ty- 
phoid, — statements continually recur of which the best that 
can be -said is that they shade from the frankly negative, or 
the evidently purposely vague, to the entirely hypothetical in 
reference to this important problem. 

As we have repeatedly pointed out, the striking spectacular 
evidence is always that of the milk-borne, or alleged milk- 
borne, epidemic, and this type has been given the entire atten- 
tion of the authorities that we have consulted, with one notable 
and authoritative exception, — Chapin. When some incidental 
reference is made to the problem of the relative significance of 
milk infection, about the only surmises hazarded are in refer- 
ence to typhoid. Three in particular have struck our attention 
forcibly from the widespread manner in which they are quoted 
as a basis for judgment. One is the now classical report by 
Harrington, in reference to 14 out of a total of 18 typhoid out- 
breaks in Massachusetts being due to milk. Another is the 
assumed 10 per cent, factor of milk infection in typhoid trans- 
mission of the Typhoid Board of the United States Public 
Health and Marine Hospital Service for the District of Colum- 
bia. We have already discussed the fairness of these two con- 
clusions in detail. A third reference is worthy of special notice, 
as it has been quoted quite as widely as the other two, and be- 
cause it may be fairly cited as a typical example of the sweep- 
ing generalizations as to the dangers of milk that can be found 
in many quarters. We refer to Whipple's well-known work on 
"Typhoid Fever." Another reason why we feel it is particu- 
larly worthy of citation is because the eminent author frankly 
admits that the assertion rests on no solid epidemiological basis, 
and because in justice to him it should be noted that in an- 
other chapter of the same work, devoted exclusively to the 
effect of milk supplies upon typhoid rates of cities, he par- 
ticularly gives this wise caution in reference to the matter: 
". . . the data for a fair discussion of this subject have not 
yet been collected." We have never found this statement 
quoted. 



163 

But very casually on another page in the chapter devoted to 
the distribution of typhoid he makes this incautious statement 
which we have found quoted, apparently with approbation, in 
numerous places: "In a general sort of way it may be said 
that in the cities of the United States at the present time 
about 40 per cent, of the typhoid fever is due to water, 25 per 
cent, to milk, 30 per cent, to ordinary contagion (including fly 
transmission), and about 5 per cent, to all other causes." 

The one good authority who challenges the fairness and ac- 
curacy of these assertions as to the high percentage importance 
of milk infection in the transmission of diphtheria, scarlet fever 
and typhoid is Chapin of Providence. In his work on "The 
Sources and Modes of Infection" he says: — 

It will be noted that though scores of outbreaks of typhoid fever may 
occur each year, they do not include more than a small fraction of the 
total typhoid fever. It may be claimed that only a small proportion of the 
milk-borne outbreaks are recognized as such, but I cannot think that 
this is so in the English cities and the better class of American cities. . . .. 
We can hardly believe that milk outbreaks could have, except rarely, 
escaped detection in the English cities, or in such cities as Boston, Worces- 
ter, Springfield, Rochester, Baltimore, Philadelphia and New York. 

The importance and value of the reports on typhoid fever in Washing- 
ton have, as it appears, given a rather exaggerated importance to the 
danger from milk. That there was a certain amount of typhoid fever 
in Washington, due to milk, during the three years in question, is no 
reason for assuming a similar percentage of milk-borne typhoid fever for 
the other cities of the country. Trask was able to find during the years 
1903-07 about 1,900 cases in the United States traced to milk. During 
this period there were in the registration area 57,023 deaths, and the 
total number in the whole country must have been at least double, or 
114,000.' The fatality is probably not over 10 per cent., so that there 
must have been at least 1,000,000 cases. Nineteen hundred is 0.19 per 
cent., which is very different from the 10 per cent, now commonly assumed 
as due to milk. I do not of course believe that all the milk outbreaks 
were reported, but the number would have to be increased -fiftyf old to 
equal 10 per cent., and it can scarcely be believed that 98 per cent, of all 
milk outbreaks fail of recognition. 

In reference to diphtheria and scarlet fever transmission by 
milk, he further states: — 

Scarlet fever and diphtheria are certainly much more rarely trans- 
mitted by means of milk than is typhoid fever. Although the percentage 



164 

of typhoid fever, scarlet fever and diphtheria due to milk is small, the 
danger is a real one and the aggregate of cases not inconsiderable and 
their occurrence should, if possible, be guarded against. 

In all this epidemiological quagmire it is refreshing to be 
able to quote at least one authoritative, incisive, sane voice 
emphatically demanding that in making our final judgments 
in this matter we take our stand upon the definitely proven 
facts, and do not pass judgment in advance relative to the 
great mass of cases of infectious diseases whose etiology we 
must as yet, in all fairness, class as unproven. 

Summary of Evidence available as to the Relative Im- 
portance of Milk in the Transmission of Infectious 
Diseases. 

To sum up, the best available information as to the propor- 
tionate part played by milk supplies in general in the trans- 
mission of the great trio of milk-borne epidemic diseases — 
diphtheria, scarlet fever and typhoid — amounts in substance 
to about as follows : — 

1. That there have been throughout the civilized world up 
to the present time a large number of well-authenticated epi- 
demics of all of these diseases, definitely due to milk infection. 
No one can state at present just how many such epidemics 
there are on record, but they are ample in number to prove 
the danger of disease transmission through raw milk. From 
the accumulated evidence it is possible to state quite defi- 
nitely that there is a vast discrepancy as to the relative 
frequency of milk infection in these diseases, diphtheria being 
clearly the least often so transmitted, scarlet fever relatively 
more often, and typhoid unquestionably more frequently than 
both the other two combined. The fourth, as yet little under- 
stood disease, that is known to be transmitted by milk — septic 
sore throat — is, in the best understanding of the term now- 
adays, considered to be practically always a milk infection. 

2. That analysis of both the epidemic and endemic records 
of these diseases in the State of Massachusetts for several years 
past would tend to indicate that the total relative importance 
of infected milk in the transmission of these diseases is not 
nearly as great as has been commonly assumed. 



165 

3. From a study of all the available literature on the sub- 
ject it would appear that three sources have been largely re- 
sponsible for the widespread impression among American sani- 
tarians that milk infection has been definitely proven to be a 
high factor in the transmission of these diseases. They curi- 
ously all relate to typhoid alone. They are: (a) Harrington's 
report of 14 out of 18 typhoid epidemics being found due to 
milk; (6) the reports of the special typhoid board on the origin 
and prevalence of typhoid in the District of Columbia; and 
(c) the milk percentage statement by Whipple in his work on 
typhoid fever. We are unable to substantiate the conclusions 
of any of these reports for reasons detailed above. 

4. Replies to inquiries among prominent American epidemi- 
ologists are unanimous in testifying that the evidence as to 
just what part milk plays in the transmission of these diseases 
is not by any means conclusive. Almost without exception 
they admit that the tendency of their own experiences is to 
explain more and more cases of these diseases on other grounds 
than milk. 

5. We can find nothing authoritative in any other general 
public health or medical literature that throws any conclusive 
light on this point. 

6. The high residual milk-borne typhoid argument of Ogan 
of the New York City Health Department is a very suggestive 
theory, but in our opinion not in any sense conclusive. 

7. Our own results do not in any sense prove conclusively that 
milk is not as important a factor as has been assumed. They 
simply go a long way towards demonstrating that the reasons 
hitherto given for the assumption that milk is a large factor 
in the transmission of infectious diseases are in many respects 
inadequate and unsatisfactory. 

In brief, it is our belief that all statements, conclusions and 
broad general impressions as to the relative dangers of milk 
found in the literature rest on a most shaky and unsubstantial 
basis. 

We believe that this tendency is wrong. The accumulated 
evidence of scores upon scores of definitely demonstrated milk- 
borne epidemics is enough to show that raw market milk is 
always a risky food. Why not let it go at that? Why lend 
color to the charge that practical milk producers so often have 



166 

flung in our faces during the progress of this investigation, viz., 
that the tendency of sanitarians to-day is to create the im- 
pression that milk is inherently little if any short of a poison. 
This impression has been undoubtedly created in many people's 
minds by sweeping, startling, unqualified accusations against 
cow's milk that may or may not be justified, and concerning 
which we have at present no sound basis whatever in the shape 
of good epidemiological proof. 

5. The Possible Means of preventing Communicable Disease 
Transmission through Milk, and their Relative Practi- 
cability. 

Enough has been shown to demonstrate that, while milk is 
probably not as great a factor in communicable disease trans- 
mission as has often been asserted, it is none the less a very 
real and serious element in the problem of communicable dis- 
ease prevention. The next logical step is to eradicate or mini- 
mize this danger. One effective way is that of Japan and cer- 
tain other Oriental races, — not to use the milk of the cow for 
human food. The great benefits that we derive from the use 
of cow's milk are so evident that such a procedure is unthink- 
able for an American community. 

There remains the problem of how cow's milk may be made 
safe as far as communicable diseases are concerned. All the 
numerous expedients and measures advocated or adopted 
throughout the civilized world with this end in view can be 
reduced to two general classifications. 

1. Efforts to produce a milk that from the cow to the ulti- 
mate consumer presents no opportunity for infection. 

2. Efforts at disinfection of the milk in some manner by 
which the opportunities for subsequent infection would be re- 

. duced to a minimum. 

In the pursuit of these ends, as in many other aspects of the 
milk problem, there has been such a strong bias or prejudice on 
the part of many advocates of these two opposing views that 
it has rather tended to obscure the fact that there might be 
a very distinct, practical and sane middle course -available be- 
tween the two extremes. 

The advocates of the cause of raw milk have blindly shut 
their eyes to certain ugly facts relative to milk and disease 



167 

transmission, and have enormously extended the prejudice pre- 
viously existing against pasteurized milk by such sensational 
catchwords and slogans as "Pasteurized milk is only another 
name for rotten milk." The advocates of sterilized milk in 
their zeal have oftentimes seemed to overlook the fundamental 
importance, on other grounds than those of communicable disease 
transmission, of having milk produced and handled throughout, 
in all the processes from cow to consumer, in the cleanest man- 
ner possible. 

The ideal of the raw milk advocate is in a phrase: Milk 
from absolutely healthy cows, milked and handled exclusively 
in all its processes of collecting, marketing and distributing by 
individuals known to be in perfect health and incapable of 
transmitting disease, who at the same time observe the most 
rigid precautions as to personal cleanliness and cleanliness of 
utensils, who keep the milk throughout these steps at a very 
low temperature, and who deliver it in the shortest possible 
time to the consumer. This ideal finds its nearest approach 
to realization in the well-known "certified milks." 

But every year of accumulated experience has demonstrated 
certain obstacles to the fulfillment of this program. The chief 
ones are these: — 

1. That only a very small percentage of milk is so produced, 
because such milk is an unusually expensive milk to put on 
the market, and thus becomes impracticable for the average 
consumer. 

2. That even these precautions do not guarantee the con- 
sumer against possible infection through milk. For example, 
the numerous instances in which a certified herd has most un- 
expectedly been found to have become extensively infected with 
tuberculosis, or such an occurrence as the great septic sore 
throat epidemic of Boston and vicinity in 1911, coming, al- 
though not from a certified supply, from a milk supply which 
was guarded by most elaborate precautions to insure a high 
degree of cleanliness and freedom from infection. 

As Rosenau pithily expresses it, "One of the features of 
special interest concerning this outbreak was that this milk 
has always been a particularly clean, fresh and satisfactory 
supply. It is obtained from tuberculin-tested cows, under con- 
stant veterinary inspection, and the milk itself is subjected to 



168 

daily chemical and bacteriological tests. The milk is bottled 
at the dairy, the bottles sterilized, and all reasonable and many 
extra precautions are taken to insure its cleanliness and purity. 
It emphasizes the lesson that raw milk is apt to be a dangerous 
milk." 

In fact, a careful and impartial study of the entire question 
will force any one to the practical conclusion that efficient dis- 
infection is our only certain safeguard against infectious dis- 
ease transmission through milk. 

Efficient disinfection can be conceivably brought about by 
either heat or chemical action. There is no chemical process 
that we can discover that will efficiently disinfect milk without 
at the same time either producing chemical changes that render 
the milk entirely unfit for food, or else will introduce substances 
into the milk, as formaldehyde, that are in themselves dele- 
terious. 

Disinfection by heat may be either by actual boiling or by 
pasteurization. Disinfection by boiling produces certain chem- 
ical changes in the composition of milk, due largely to the 
coagulating of the milk albumen, which materially affects the 
flavor. Nevertheless, it is the procedure of choice in many 
European countries. 

Since it has now been firmly established that pasteurization 
properly carried out is an absolute protection against patho- 
genic micro-organisms that may have accidentally infected milk, 
and since this process, carried out at proper temperatures and 
with proper subsequent handling of the milk, produces no 
change in the flavor or appearance, and no chemical changes 
of any practical consequence, pasteurization has become firmly 
established in America as the disinfection process of choice. 

6. Pasteurization as a Means of Infectious Disease Prevention. 

Pasteurization is considered in another section from various 
angles. Here our only interest in the process is the question 
of its efficacy as a means of preventing the transmission of 
communicable diseases through milk. 

In the past many arguments have been raised against pas- 
teurization. Unfortunately, in its beginning as a commercial 
practice in the milk industry of this country, pasteurization 



169 

received a bad name which the easily demonstrable benefits of 
the process have never been able to live down. 

Pasteurization, as first resorted to in America, was in spirit, 
if not in law, a plain, palpable fraud. The process was origi- 
nally utilized by dealers to keep dirty milk in a marketable con- 
dition longer than could otherwise be done. This naturally 
had the effect of aligning health authorities against the process. 
It was many years before sanitarians generally came to appre- 
ciate that this abuse of pasteurization was not any real argu- 
ment against the benefits of pasteurization. 

Then several authorities brought forward the argument that 
the process of heating milk produced certain chemical changes 
that rendered the milk less suitable for infants' diet, and that 
long-continued use of pasteurized milk tended to produce the 
disease known as infantile scurvy. Several years of heated dis- 
cussions on this point succeeded in effectually settling this ob- 
jection by proving (1) that the disease, infantile scurvy, was 
comparatively rare; (2) that it was at least doubtful whether 
pasteurization of the milk was the cause; and (3) that it could 
be both prevented and cured by the addition of fruit juices, 
or animal or vegetable albumin, in simple and easily digestible 
form, to the child's diet. 

With this objection disposed of the opponents of pasteuriza- 
tion took refuge in the claim that heating milk killed the "life" 
of the milk. No one has ever been able to demonstrate just 
what the "life" of milk is in the sense in which the objection 
was originally used. New milk has a certain inhibitive power 
over bacterial growth, but this is lost after eighteen hours, or, 
in other words, some time before the ordinary market milk of 
our larger cities can possibly reach the market. Milk is "dead" 
and begins to decompose from the moment it is drawn from 
the udders, — sometimes before milking. 

There are several so-called enzymes, or ferments, in milk the 
exact nature of which is still in controversy, but none of these 
are in the least affected by the temperature to which milk is 
heated in the process of pasteurization except two that, so far 
as any one can determine, have no effect upon health. 

Another objection that has more weight, and that has often 
been raised against pasteurization, is that the process, by de- 



170 

stroying the lactic acid bacteria which normally bring about 
the souring of milk, destroys "Nature's danger signals." This 
argument would be much more effective if it were not for the 
fact that pasteurization at the temperature recommended, while 
it kills all disease germs, does not destroy all the souring bac- 
teria. These will again multiply, and hence souring is only 
delayed, not prevented, by efficient pasteurization at approved 
temperatures. Nature has no danger signal in milk. Sour milk 
is not harmful. Infected milk looks and tastes well. 

The great and original objection to pasteurization — i.e., that 
it promotes dirty, careless methods of milk production, and 
leads milk handlers to believe that it is immaterial how much 
cow dung or other filth gets into the milk — is still the one 
chiefly used by the opponents of pasteurization. . 

This entire objection falls to the ground if once the sanitary 
prerequisite is firmly established that milk must be reasonably 
clean to be eligible to pasteurization. 

When the positive benefits of pasteurization are considered, 
the evidence is so overwhelming as to admit of no answer. 
Proper pasteurization kills all the germs of the communicable 
diseases of man that can possibly be transmitted through milk. 
Pasteurized milk is the only safe milk. 

Pasteurized milk in this sense means milk heated to not less 
than 140 degrees, nor more than 150 degrees F. (preferably 
145 degrees), for not less than twenty minutes (preferably one- 
half hour), then cooled quickly and kept cool and free from 
contamination until delivery to the ultimate consumer. 

Milk so treated is just as digestible, just as nutritious and 
just as palatable as the raw milk, and this is the simplest, 
cheapest and best method of making milk safe from the danger 
of transmitting communicable diseases. The certain protection 
that pasteurization gives against infection with bovine tubercle 
bacilli in itself far outweighs all the economic, esthetic or sani- 
tary objections that can be brought against the process. Fur- 
thermore, the process is, as Rosenau says, too important a 
health matter for its methods of carrying out to be left under 
the care of any other agency than that of the health authorities. 

No one denies that, except when pasteurization is carried out 
in the final container, there is always a more or less remote 
possibility of the milk being reinfected, before it reaches the 



171 

ultimate consumer, from direct contact by a convalescent or a 
chronic disease carrier. With this limitation clearly understood, 
the efficiency of pasteurization as a disease-preventive process 
becomes the more remarkable when we reflect upon the as- 
tounding fact that, in spite of the hundreds of well-authenti- 
cated outbreaks of infectious diseases definitely proven to have 
been due to infected milk, and in spite of the ever-increasing 
percentage of pasteurized milk placed on the markets of the 
large cities of this country in the past twenty years, there has 
never yet been an important outbreak of a communicable disease 
that could be attributed to a pasteurized milk supply. For this 
statement we have no less an authority than Assistant Surgeon 
General Trask of the United States Public Health Service, 
under whose direct personal supervision the prevalence of com- 
municable diseases, not only in this country but throughout 
the world, has been carefully studied for many years. Writing 
under a very recent date, Nov. 24, 1915, in response to an 
inquiry on this point, he states: "I have no record of any 
epidemic or outbreak of any size that was milk-borne on a 
pasteurized milk supply." 

There have been a few instances in which an outbreak of 
communicable diseases has occurred on a milk supply which 
Was alleged to have been pasteurized, or on the route of a 
dealer who handled both pasteurized and unpasteurized milk, 
from which the impression at first was that the milk came 
from the pasteurized source. In every instance on record in 
which such an occurrence has been investigated it has been 
found that no real, pasteurization of the milk supply had been 
carried out. Either pasteurization was claimed when it had 
never been in effect, or else the machinery for carrying out 
the pasteurization was at the time of the outbreak out of com- 
mission either by accident or neglect. In certain of these in- 
stances, when the pasteurizing machinery got out of order, 
there was at least a strong suspicion that the pasteurizer may 
have acquired only a sufficient amount of heat to act as a 
bacterial incubator rather than as a bacterial sterilizer. The 
ever-present possibility of such accidents occurring in pasteuri- 
zation, even although experience has proved them to be ex- 
tremely infrequent, makes the need for efficient governmental 
* supervision of pasteurization doubly essential. 



172 



C. MILK AND INFANT MORTALITY. 

By the "infant mortality rate" we mean the number of 
infants under one year old who die as compared to the number 
born during that year. To know this we must know' how many 
are born and how many die. The registration of both births 
and deaths is so incomplete in the United States that these 
figures are not obtainable for our country as a whole. 

The Massachusetts figures, which are fairly accurate, are 
steadily improving. 



Yeab. 



Rate per 
1,000 born. 



1900, 

1905 

1910, . . ■ 

1914 ! 



156.7 
139.0 
135.6 

104.53 



In Boston the figures were, in 1910, 126 per 1,000 born; in 
1914, 102.23; from 1909 through 1913 the average annual rate 
was 120 per 1,000 born. 

In foreign countries the data obtainable are not quite so 
recent. 



Country 

Scotland, 

Norway, . . . ■ . 

Sweden, '. 

France, . . . 

Austria 

Russia, 

England, 

Wales, 

New Zealand 



Years. 



Average 
Rate. 



1893-1902 
1893-1902 
1893-1902 
1893-1902 
1895-1900 
1890-99, 

1901-05, 

f 1910, 

1911, 

1 1912, 



127 
94 
99 
158 
227 
272 

138 



Our Massachusetts rate is not by any means the highest in 
the world, but it cannot be considered in the same class with 



173 



that of New Zealand, the lowest. We pride ourselves on our 
knowledge of science and scientific methods, yet in the matter 
of the reduction of infant mortality we are not even in the 
advance guard of the nations. 

The causes of infant mortality are many and complicated. 
The following table shows the relative importance of the prin- 
cipal causes as stated by Dr. Emmett Holt of New York, an 
eminent authority, by the Maryland State Board of Health, 
and by Drs. Koehler and Drake of Chicago. 



Holt. 



Percentages due to: — 
Diarrhceal diseases, 
Congenital defects and childbirth, 
Pneumonia, bronchitis, influenza, 
Acute contagia, 
Tuberculosis, .... 
Venereal diseases, 
All other causes, 



28.0 
31.3 
18.5 
5.4 
2.0 
1.2 
13.6 



Maryland 
State Board 
of Health. 



38.5 

17.1 

14.7 

5.0 

2.5 

22.2 



Koehler and 
Drake. 



39.8 
24.0 
20.6 
3.2 
1.6 
1.3 
4.8 



Cow's milk as an infant food might enter prominently into 
the following of these causes: Diarrhceal diseases, acute con- 
tagia and tuberculosis. 

Its significance in the acute contagia and in tuberculosis are 
considered in another portion of this report. 

According to the majority of authorities, failure on the part 
of mothers to provide breast milk for their children appears to 
be on the increase throughout the civilized world. 

Spargo says: — 

The modem mother is growing more and more unable to nurse her child 
at her breast. For some subtle reason this function of maternity is being 
atrophied in civilized women; and the higher their civilization the less 
able are they to suckle their children. With the vast majority of women 
who find themselves unable to discharge this important maternal duty 
the trouble is not social or economic but physiological. 

Dr. Holt tells us that among the well-to-do and cultured 
mothers not more than 25 per cent, of those who have earnestly 
and intelligently attempted to nurse have succeeded in doing 
so for as long as three months. Among the poorer classes in 



174 



our cities there is also a marked decline in nursing ability, al- 
though not yet to the same degree as among those higher in 
the social scale. 

On the other hand, according to Dr. Herman Schwartz of 
New York, based on observation of 1,500 babies, 96 per cent, 
of the mothers were able to nurse their babies for one month 
or less. He says: "This proves very conclusively that if care 
is taken from the very start most women can do something 
toward nursing their children." 

With every failure in the ability of a mother to nurse her 
child comes the demand for a substitute food for the infant. 
No ideal substitute has been found. Many milks have been 
used which approximate more or less closely to human milk 
in composition. Because of the quantity needed, because of 
the establishment of the dairy industry in this country and 
its consequent availability, because it can be modified com- 
paratively readily to a close approximation to human milk, 
cow's milk has been and will be our main standby. It then 
follows that if we are to provide cow's milk as a substitute 
food for our infants we must see to it that this substitute 
saves as many infants' lives as possible and kills as few as 
possible. 

The composition of human milk differs from cow's milk, as 
follows : — 





Protein. 


Fat. 


Milk Sugar. 


Mineral 
Matter. 


Human milk 


1.6 
3.2 


3.4 
3.7 


6.1 
4.9 


6.20 
0.75 



The greatest difference is in the protein content. Protein is 
the muscle-building element. In cow's milk it is present in 
a greater quantity in proportion to the other elements than 
the human body requires. To get a sufficient amount of milk 
sugar from unmodified cow's milk a large excess of protein and 
a lesser excess of fats would be taken. On the other hand, to 
secure proper amounts of protein would be to take an insuf- 
ficient supply of fats and a still less sufficient supply of milk 
sugar. Again, the protein in cow's milk is of a different chem- 



175 

ical composition from that in human milk; it forms a tougher 
curd and is more resistant to digestion. The fat in cow's milk 
is in larger globules and has a higher melting point than the 
fat in human milk. Raw, unmodified cow's milk is an unnat- 
ural and badly balanced food for infants. By proper modifi- 
cation the proportion of the different elements can be brought 
to correspond to the proportions in human milk, but the chem- 
ical variations in the proteins and the fats cannot be brought 
to correspond. 

Human milk as administered by breast feeding requires no 
intermediary handling or storage, and is taken into the child's 
stomach with a minimum of contamination and of bacterial 
content. Cow's milk must be handled by milkers, transporta- 
tion agents, dealers and mothers or attendants with ever- 
present opportunities for contamination by dirt and disease 
germs. It must be stored in containers, and is more or less 
often transferred from one container to another with the at- 
tendant dangers from dirty vessels or diseased handlers. The 
necessary time elapsing between milking and feeding gives great 
opportunity for increase in the bacterial content. All these 
factors occurring at all stages of the route of the milk from 
the cow's udder to the baby's stomach — on the- farm, on the 
road, in the distributor's hands and in the home — furnish 
opportunities to render a clean milk dirty, a pure milk infected. 

Milk, whether from the cow or the woman, is produced at 
body temperature. Both, as secreted, are naturally sterile. 
Both may be infected in the process of milking. Bacteria mul- 
tiply but little at a low temperature, but milk, at summer tem- 
perature, becomes an excellent culture medium for many vari- 
eties. The question whether the germs of communicable diseases 
of man may multiply in milk to any great extent is still dis- 
puted. However, it is not disputed that disease germs live for 
varying but considerable periods of time in milk, when once 
introduced, and are transmitted by it to their natural environ- 
ment, the human body, and there multiply and produce their 
specific disease. 

Cow's milk, unless properly cooled and kept cool during the 
time elapsing between production and consumption, becomes 
loaded with bacteria and their products. Reasonable protec- 



176 

tion, therefore, demands this prompt cooling and continuous 
holding at the safe temperature. 

Dirt, with its accompanying dangerous chemical and bac- 
terial elements, may be introduced into the milk at any or all 
stages of its journey, — from dirty udders, teats and flanks of 
the cow; dirty hands of the milker; dirty methods of milking; 
dirty stables and pails; dirty washing water; dirty milk ma- 
chinery; dirty distributors, wagons and bottles; dirty utensils 
in the home; dirty attendants; dirty mouths in the babies, 
etc. 

Cow's milk for infants is a primarily ill-suited food that is 
in constant and continuous danger of becoming a positively 
toxic food at every stage of its existence as milk. If, however, 
the natural supply of infant food fails, something must be pro- 
vided in order to prevent starvation and death, and it is our 
office to see to it that the substitute is as little toxic as possible. 

The Place of Cow's Milk as a Cause of Infantile Diarrhoea. 

In wholly breast-fed babies it can have no effect; in partly or 
wholly bottle-fed babies it is of primary importance. 

The proportion of breast-fed to bottle-fed babies in our in- 
fant population is an unknown quantity. 

It is stated that in Norway and Sweden nearly all infants 
are breast fed; in Scotland 80 to 85 per cent, are breast fed; 
in France there is little breast feeding; in Russia little breast 
feeding; in Austria breast feeding is predominant in the upper 
classes, artificial in the lower; no definite statements regarding 
England and Wales could be found, but all comment indicated 
a large percentage of bottle feeding; in this country the general 
impression is that breast feeding is steadily declining. 

In Chicago, during July, August and September, 1911, ac- 
cording to reports from visiting nurses, there were, among the 
infants visited by them, 15,861 breast-fed infants and 5,477 
bottle-fed infants. Dr. W. H. Davis states that in Boston, in 
1911, out of every 100 babies 68 were breast fed and 32 were 
bottle fed, and that of the 621 deaths of infants from diarrhoea 
and enteritis in Boston during the same period 87 were breast 
fed and 534 were bottle fed. In other words, 6 bottle-fed in- 
fants died of intestinal trouble to 1 breast fed, and there were 



177 

not half as many bottle-fed babies in the city as there were 
breast fed. 

Authorities' the world over agree almost without exception 
that the mortality of bottle-fed infants is frightfully in excess 
of the mortality of breast-fed infants, and that this excess of 
mortality is in great measure due to intestinal disturbances or 
communicable diseases caused by contaminated or infected 
milk. 

The health of the cow is the first factor in pure milk pro- 
duction. No one would expect to get a milk absolutely free 
from dangerous possibilities from a sick cow. Of about the 
same importance is the health of the person taking care of the 
cow. Our records of communicable diseases, showing how in 
many instances a case of disease at the dairy is spread along 
the milk route in epidemic form, prove the actuality of this 
danger. 

Cow dung in the milk is at least undesirable from the stand- 
point of the average consumer. Many of our best pediatricians 
believe that it is a positive danger. An uncleaned cow or an 
uncleaned milker, an uncleaned stable or a stable cleaned fat 
the time of milking, uncleanly methods of milking, straining, 
cooling or storing milk, — all give frequent opportunities for 
this contamination. 

The use of simple and easily learned, clean methods protect 
milk from dirt to an astonishing degree; clean cows, clean 
stables, clean milkers and the small-top pail work wonders. 

The dirt that does the most harm in milk is bacterial. Milk 
at a temperature approaching body heat is a very perfect cul- 
ture ground for many bacteria. Counts of bacteria content 
show a steady and extraordinary rapid increase in the number 
of bacteria in milk that is held warm, and this increase is 
measured largely by the length of time it is so held. On the 
other hand, milk at 50° F. or lower is not a good culture 
medium, and milk that is cooled immediately after milking to 
that temperature and held at that temperature can be stored 
for a comparatively long time without showing great increase 
in its bacterial content. 

In the milk business proper cooling of the milk and holding 
it cold is not a complicated process, but like many other simple 



178 

processes it is difficult of execution because it has to be per- 
fectly carried out to insure safety. Failure to cool immediately 
and to hold cold constantly and continuously spells bacterial 
growth. To be safe it must be held cold through the whole 
journey from the cow to the baby, in the dairy, during collec- 
tion and transportation, at the dealer's, during distribution and 
at the home before use. It is a long chain, and, like all chains, 
if a weak link develops it will break there and be worse than 
useless. 

Of late years there has been much legislative discussion aimed 
at the control of the production of milk. Cattle and dairies 
are more or less thoroughly inspected, and milk dealers adver- 
tise and show to the public as well as to the inspectors the 
cleanliness and safety of their methods of handling milk. By 
constant watchfulness a certain measure of protection is being 
secured up to the point of delivery of the milk at the home. 
After that point is reached the elements of human ignorance, 
poverty and carelessness come into the question where they 
are beyond the control of legal remedial measures. That a 
very large proportion of the contamination of milk at the 
present date occurs in the home seems to be the common con- 
clusion of investigators. 

Mr. W. E. Kreusi, of the Milk and Baby Hygiene Associa- 
tion of Boston, testified in 1910 as follows: — 

The committee regards the milk situation very much better with 
respect to conditions at the producer's end, and very much better as to 
conditions in the contractors' and peddlers' hands, than in the hands of 
the ordinary consumer. 

The effort to save babies' lives through baby feeding and 
milk stations has gained enormous headway, and has produced 
very definite and highly satisfactory results. As these organi- 
zations were originally instituted their object was to furnish a 
pure, clean milk as a food for infants. A notable example of 
this was the establishment of milk depots in New York through 
the philanthropy of Mr. Nathan Strauss. It soon became evi- 
dent that this did not solve the problem. As one of Dr. Price's 
nurses in Detroit put it, "To successfully combine milk with 
a baby you must take care of the baby as well as the milk." 



179 

The home conditions, the care of the milk at home, and the 
general hygiene of the baby were evidently as important or 
even more important than the exceptional original purity of 
the milk. The follow-up nurse was introduced, who went to 
the home, advised sanitary improvements and taught the igno- 
rant mother the simplest principles of the hygienic care of the 
baby as well as of the milk. Dr. Price of Detroit reversed his 
infant mortality rates — made them lower in the hot months 
than they had been in the cold — by the use of nurses alone, 
not nurses combined with milk stations. 

In the past the cause of summer diarrhoeas in infants has 
been almost always charged up to bad milk. It was admitted 
that other factors entered in, but it was believed that they 
did so to so small an extent as to be comparatively negligible. 
Prompted by the results obtained by the work of the visiting 
nurse, studies are being made that are showing the unexpect- 
edly large measure of importance of factors other than sanitary 
milk. 

Dr. Arthur Newsholme, an eminent English sanitarian, in a 
study of 1,259 infants during an epidemic of infantile diarrhoea, 
found that artificial feeding was the habit, either wholly or in 
part, with the large majority of cases of the disease, showing 
the value of breast feeding; but also he found that babies fed 
on condensed milk were twice as susceptible to the disease as 
were those fed on fresh cow's milk, showing that it was rather 
the artificiality of the feeding than the cow's milk as a food 
that was responsible. Also from this series it might well be 
argued that cow's milk was the best substitute food if a sub- 
stitute must be used. 

Prof. C. E. A. Winslow of New York finds that, in the case 
of infants, bad ventilation and indoor heat are almost as im- 
portant causative factors in diarrhceal as they are in respiratory 
diseases; that heat alone has a marked effect on the baby. 
In a series of infants who were either breast fed or fed from 
bottles under the best conditions he found that while 80 per 
cent, of them did well during the winter, only 60 per cent, did 
well during the hot months, showing the important definite 
effect of heat alone. 

Holt and Park say: — 



180 

The depressing effects of great atmospheric heat, i.e., a temperature 
in the neighborhood of 90° F. or over, were very marked in all infants 
no matter what their food. Those that were ill were almost invariably 
made worse, and many who were previously well became ill. 

Dr. J. .W. Shereschewsky of the United States Public Health 
Service, in discussing the effects of heat on infant mortality, 
concludes that the action of heat as a direct cause has been 
greatly underestimated; that it is the indoor heat common in 
poor housing conditions that is responsible; that the respon- 
sibility of dirty and stale milk has been overestimated, although 
breast feeding must still be regarded as a most, if not the most, 
important preventive of the summer deaths of infants; that 
future activities for the prevention of infant mortality must 
concentrate themselves to a greater extent on the improvement 
of housing conditions, and on education regarding the proper 
care of babies in the summer. 

Infants are delicate machines. It is not necessary that they 
should be bottle fed to endow them with a high death rate. 
Incomplete development, inherited constitutional weaknesses or 
disease, excessive heat, high humidity, poor ventilation, im- 
proper clothes, accidents and the various communicable dis- 
eases are all factors in it. 

The experience of this State seems to be that the causes of 
infant mortality cannot be charged in the majority of cases to 
the condition of the milk supply as delivered at the door. Un- 
questionably this is the cause in many cases of death, but not 
in a preponderance of them. 

Dr. Gerstenberger of Cleveland, after stating that 300,000 
under one year of age die yearly in the United States, says he 
wishes to call your attention emphatically to the fact that at 
least 50 per cent, of these are dying without any real cause, 
simply from ignorance of the parents, their advisors, — they 
are the physicians and nurses, — and from ignorance of the 
public at large. Most parents, especially the more poorly situ- 
ated, have but the slightest conception of the proper hygiene 
of the child and its surroundings. The big bulk of advisors of 
the parents — the physicians and nurses — are too ignorant to 
train and advise parents "because not especially trained for 
this." The public does not appreciate how many lives are 



181 

lost, and does not know that the power to remedy the condi- 
tions at fault lies in its hands, and its hands alone. 

Dr. Newsholme states that while infections resulting in in- 
fantile diarrhoea are possibly introduced on the farm, in his 
opinion the majority are of human origin, and closes his sum- 
mary with the following : — 

In balancing up the above facts and considerations I have no hesitation 
in adhering to the opinion stated in many of my past annual reports, — 
that diarrhoea is mainly due to domestic infection. 

i 

On the other hand, many believe with Dr. Henry L. Coit 
of Newark, N. J., that our reliance should be placed on the 
production of a safe, raw, "certified" milk, controlling it by 
flawless inspection from the cow to the consumer; that if we 
provide an absolutely safe milk to begin with we minimize the 
dangers in the use of cow's milk as an infant food. 

What are the remedies? 

1. We must insure a clean, safe milk. 

2. We must educate mothers. 

1, Insuring a Clean, Safe Milk. 

Efforts to secure such a milk supply have occupied the Legis- 
lature a goodly amount of time in the past. It is obvious that 
hygienic conditions in the dairy, in transportation and in the 
sale and delivery of milk can be secured only by constant 
supervision. Where a reasonably safe line between expense 
and results can be drawn can only be determined by experi- 
ence. It will be best to err on the side of safety. Since the 
health of the milk handlers is a matter of importance in the 
transmission of communicable diseases, and since many of these 
diseases are transmissible before identifiable symptoms appear 
in the patient, it follows that the most carefully inspected, 
"certified" milk may become infected in spite of the most 
faithful and detailed inspection. As long as human beings are 
fallible, so long will contaminating accidents be possible at any 
point between the cow and the final consumer. 

Heating milk to the boiling point, sterilizing it, frees it from 
live bacteria. In Amsterdam, Holland, the entire supply of 



182 

the city is boiled to protect against epidemics. In Europe, in 
general, milk is cooked. Advocates of this system extol the 
absolute freedom from bacteria and the consequent safety of 
the milk. Opponents argue that there is a chemical change 
resulting from the heat that changes the digestibility of the 
milk and causes digestive disturbances in the consumer, and, 
in particular, results in infantile scurvy. Many experiments 
by European and American investigators seem to show that 
this viewpoint is not supported by fact to a demonstrable 
degree. This process does change the taste of the milk, pleas- 
antly to some and unpleasantly to others. 

Heating milk to between 140° and 167° F., and holding it at 
that temperature for twenty minutes, kills the germs of all 
the communicable diseases so far as we know them. This 
process is known as "pasteurization." The efficacy of pas- 
teurization in the control of milk-borne epidemics has been 
frequently proved in the State. It certainly does kill the dis- 
ease-producing bacteria, if properly performed. Advocates of 
pasteurization base their arguments on the results obtained in 
the reduction of infant mortality following the institution of 
the process. Opponents state that the rendering milk safe by 
this process puts old, stale, decayed milk on an even footing, 
from the standpoint of salability, with clean, fresh milk, and 
there is no escaping the conclusion that, in part at least, they 
are justified. They also argue that, just as in "cooked" milk, 
there is the possibility of resultant scurvy in the consumer. 
In this particular their arguments appear to be unsubstantiated. 

In the Transactions of the Second International Congress on 
the Milk Industry, held in Paris in 1905, Dr. H. de Rothschild, 
speaking of infantile scurvy, refers to objections raised to pas- 
teurization on the ground that it causes this disease. He says 
that a careful study made by him for ten years showed only 
23 cases in the whole of France; and that he is forced to con- 
clude that if such a process is effective in the reduction of 
gastroenteritis, tuberculosis and typhoid fever, to base an ob- 
jection to its use on the ground that it may cause a disease 
that has occurred but 23 times in ten years is not valid. 

One or more of these three methods of securing a clean, pure 
milk are used in communities the world over with success that 
is more or less perfect. The majority of observers seem to favor 



183 

a combination of thorough inspection followed by pasteuriza- 
tion, — not overlooking or belittling the immense advantage 
of clean production and distribution, but augmenting that by 
the additional safeguard of pasteurization. 

Dr. Henry Helmholtz of Chicago says on this subject: — 

There are those who would prevent all infant mortality if they could 
only feed all children of the tenements a pure, clean, raw milk. There 
are those who would accomplish the same end by feeding them, one and 
all, pasteurized milk. In each case they do not realize that infant mortal- 
ity is a very complex problem, and that either one of these things is only 
a small factor, and that when it comes to the feeding end of the problem 
perhaps the most important thing is not so much what is fed as the way 
in which it is fed. 

2. Educating Mothers. 

As pointed out earlier, the contamination of the milk after 
delivery at the home is perhaps our most common present 
source of danger. No matter how pure and clean the supply, 
dirt added there renders the article just as deleterious as dirt 
added at any point previously, allowing only for the length 
of time between pollution and use and its proportionate bac- 
terial growth. The mother who lets milk stand in a dirty 
pitcher in the sun for an hour or two, then pours it into a 
stale pan and puts it, uncovered, into a half-cooled refrigerator 
full of stale articles of food, and who goes through the long 
list of dirty methods of getting it into a baby's uncleaned 
mouth, is just as crassly ignorant or as criminally careless as 
the unhealthy producer who milks unhealthy and uncleaned 
cows in a dirty stable into dirty utensils, and the results to 
the infant are just as fatal. 

We have laws and regulations which, according to our ex- 
perience, are controlling the producer and the dealer to some 
degree, — many believe to a large degree, — but we have no 
way of reaching by legal means the consciously, or uncon- 
sciously, dirty woman in her home. The dirtiness is both 
visible and invisible, whether added by the producer or the 
housekeeper. There is no excuse for visible dirt in either case; 
it can be explained in only one way. Bacteriological dirt is 
not visible, and its presence may be due either to ignorance, 
to carelessness or to a wilful disregard of teaching. Women 
do not want their babies to die. When they are told where 



184 

the danger lies, and really believe that it does lie there, 
there is not much wilful disregard left. If the teacher can 
check up how well her instructions are being carried out there 
is not much room for carelessness. Most women with a young 
baby have not much time to go to school, nor can they leave 
their babies unattended while they do; therefore the school 
must be made to come to them. 

So far we have evolved just one agency that answers these 
requirements, — the visiting nurse. The mother believes that 
the nurse knows what she is talking about; that she is not 
visiting her to make capital out of her, but to protect her 
baby; that she is a woman and cannot help loving babies; in 
short, she gives her her complete confidence. The nurse's visits 
are frequent, and the mother does not have much time to get 
rankly careless between them. At each visit the nurse brings 
the school to the home in lessons graded and fitted to the per- 
sonal intellectual capacity of the woman. 

Combine this system of education with a pure milk supply 
and we have the framework of our present-day methods in the 
attempt to reduce our infant mortality rate. 

Associations and institutions all over the civilized world are 
using this method with a success so universal and so generally 
appreciated that no statistics are offered. 

Summary. 

The infant mortality rate is still higher than it should be, — 
higher than the investigators feel is inevitable. A still unde- 
termined part of this excess is due to the quality of infant's 
food and the method of its administration. Breast milk is the 
natural food for the infant. When this maternal function fails 
a substitute food is required. Modified cow's milk is the com- 
mon substitute, although it has inherent qualities that make 
it an imperfect food for infants. The supply for our cities 
must be brought from a distance. It may become polluted at 
any time between its secretion in the cow's udder and its diges- 
tion in the stomach of the infant. To make it reasonably safe 
it should be controlled by inspection and pasteurization up to 
the point of delivery at the home, and controlled after delivery 
by the education of the mother in hygienic methods. 



185 



D. THE NUTRITIONAL VALUE OF MILK. 

After trying to digest the mass of conflicting evidence in the 
various aspects of the danger to the public health from milk, 
— a subject that from the nature of the evidence obtainable 
must be insusceptible of definite proof, — it is a pleasure to 
approach a subject in which some definite facts can be stated. 
Further, it appears to us that, especially in popular discussions 
of the milk question, the emphasis has been generally laid on 
these dangers, passing over the enormous value of milk to the 
human race with a very light touch; therefore it is doubly a 
satisfaction to register our appreciation of the unique place 
held by this sterling and indispensable food. 

The universal use of milk as an ingredient of a large pro- 
portion of the products of- the kitchen has perhaps made us 
lose sight of its prime individual value as a complete food in 
itself, and of the fact that it is the only single article of our 
foodstuffs which is so constituted, and is in itself so balanced 
and complete a ration, that human life can be sustained on 
it alone for a long period. For infants human milk is the per- 
fect food. As referred to elsewhere in this report, a substitute 
food is frequently called for because of the failure of the mater- 
nal supply. As also stated, for economic reasons and because 
of custom, cow's milk is the usual substitute in this country. 
Cow's milk and human milk are near enough alike in the pro- 
portion of their constituents so that by simple means — so 
simple that a person of average mentality can understand and 
carry them out — cow's milk can be made sufficiently digestible 
food for the average infant. This is particularly true in cases 
where the mother has been able to nurse her child long enough 
to get him well started in life. With many infants, however, 
the chemical differences between the milk of the cow and of 
the woman render cow's milk, however modified, an unsuitable 
food for them. 

As compared with the corresponding constituents in human 
milk, the proteins in cow's milk are more abundant and form 
a tougher, less flocculent cord, which is less easily penetrated 
and dissolves more slowly in the digestive fluids. The propor- 
tion of casein in the proteins is larger, and of lactalbumin, 



186 

smaller. The fats in cow's milk occur in larger globules and 
have a higher melting point. The sugar in cow's milk is less 
in amount, but identical in composition. The salts in cow's 
milk are more plentiful, and are those of lime and magnesium 
instead of those of potassium and sodium. Further, while both 
are alkaline when drawn, the cow's milk soon becomes acid 
and is usually so when used in the home. These chemical dif- 
ferences are inherent and unavoidable. As milk ages, further 
changes take place as the result of bacterial action, which are 
more or less deleterious to the infant. The conditions under 
which milk is transported and stored, and the time elapsing 
between milking and consuming, are directly concerned in these 
changes. 

Faulty methods of production, distribution and receiving and 
caring for the milk at the home give opportunities for pollution 
of and consequent changes in the food value of milk. But in 
spite of these drawbacks modified cow's milk is the almost uni- 
versal substitute infant food in this country, and is a generally 
adequate and satisfactory substitute. Its value to us as a food 
for infants cannot be overestimated. It is indispensable. As 
a possible negative proof of the value of cow's milk as infant's 
food the following is of interest: In a New England city of 
120,000 inhabitants the total daily consumption is 27,000 quarts 
of raw milk, or .22 quart per capita, and 5,000 cans of con- 
densed milk. The infant mortality rate is 171 per 1,000. In 
investigating the subject the local board of health states that 
raw milk is used for infants in very much smaller amounts than 
it should be, condensed milk, beer and coffee being used in- 
stead. Dr. Howarth of Derby, Eng., is quoted by Newman 
as follows: "Children fed on condensed milk show a very 
high mortality, viz., 255 deaths per 1,000 of children so fed." 
Physicians would not ordinarily advise the use of beer and 
coffee as a substitute for mother's milk. It is conceivable that 
the freer use of raw milk as a food for infants would result in 
a lowering of the infant mortality rate in this particular city. 

The value of milk as a food for adults is, as a rule, rather 
under than over estimated. The digestive apparatus of the 
adult can disregard the chemical unsuitabilities with far more 
impunity than can the infants'. The worst feature of milk as 
a sole food for healthy adults is that it is too wholly digestible; 



187 

it does not contain in itself enough waste matter. The intes- 
tines of an adult have been accustomed to a good percentage 
of bulky, inert matter to serve as a vehicle for body wastes in 
their discharge. Milk itself does not provide this bulky waste, 
and for this reason may well be characterized, as has been done 
by Rosenau, as "too perfect food for the adult." Although 
perhaps "too perfect" for the healthy adult, this stricture can- 
not hold in the case of the sick adult. Here its easy digesti- 
bility and perfect balance as a food make it about as indispen- 
sable as it is in the case of the motherless infant. Dr. George 
W. Gay, in his testimony before the milk committee of the 
Massachusetts Legislature in 1910, emphasized very strongly 
the value of milk to the sick adult. He said, "Milk is the 
chief food of sick folks. We could not take care of sick folks 
if we did not have milk. The importance of milk as a food 
for sick people — adult sick people — cannot be overstated or 
overestimated . ' ' 

Here, again, the pollution or contamination of the milk before 
it is swallowed may reduce its suitability as a food to the point 
of rendering it absolutely dangerous even to healthy adults; 
far more to sick ones. 

And, again, the statements as to its food value hold good. 
Its place as a food for adults, particularly sick adults, cannot 
be overestimated; it is indispensable. 

As compared with other foodstuffs its value is very high, so 
high that at present prices it is one of our cheapest of foods. 
As a readily understood comparison take the following: An 
adult man would need from 4 to 5 quarts of milk daily to 
supply his food requirements. The food value of 4 quarts of 
milk, if expressed in common foods, would provide the follow- 
ing amount as a daily supply: — 

4 eggs. 



4 quarts of milk, 



f pound lean beef. 
2 pounds potatoes. 
1 pound cabbage. 
\ pound bread. 
J 4 pound butter. 



This is not offered as a balanced ration, but as a showing of 
the actual food value of milk. In view of this great economic 
value of milk as a food the waste that takes place in certain 



188 

phases of the milk business is much to be regretted. The de- 
mand of the public for cream, as such, leaves a large amount 
of skimmed milk that has an uncertain market. Skimming 
milk removes about two-thirds of the fats, and hardly touches 
the proteins and carbohydrates, and the proteins are the 
muscle-building part of the milk. On the farm this skimmed 
milk is used in the family, fed to swine, calves or chickens, or 
thrown away. When used for feeding, of course this valuable 
food is not wasted in its entirety, but even then it is using 
food of a very high nutritive value where a less valuable one 
might possibly be substituted, provided a suitable use could 
be found for the skimmed milk. Where it can be obtained in 
large quantities, large enough to warrant the investment, it is 
manufactured into casein, when the milk sugar is entirely lost. 
In the aggregate large quantities of skimmed milk are wasted 
through the lack of intelligent demand for a valuable article. 
Determined by the chemical analysis, with the retail price of 
whole milk at 9 cents per quart, the actual value of skimmed 
milk is 4.6 cents per quart, and its retail market price at date 
is about 2 cents per quart. When people realize that for 2 
cents they can get an article whose actual value is 4.6 cents, 
it would seem that the demand for it must increase, that the 
price will rise and the waste be checked. 

SUMMARY OF PART V. 

A number of the human communicable diseases are trans- 
mitted through milk. Those of the most importance in Massa- 
chusetts are tuberculosis, diphtheria, scarlet fever, septic sore 
throat and typhoid fever. 

In tuberculosis the milk may be infected by the cow produc- 
ing it, or by the human beings who handle it. 

In the other four diseases mentioned, except possibly in the 
case of scarlet fever, the infection does not originate in the 
cow; the source is in the human handlers. 

The amount of communicable disease transmission through 
cow's milk has been overestimated, but such transmission does 
occur in a degree of frequency which demands public protection. 

The infection of milk with human disease germs may occur 
at any time between its secretion in the cow and its consump- 
tion. 



189 

In addition to infection with human disease germs milk may- 
be otherwise polluted, or may decay to a degree that renders 
it an unsafe food for human beings. 

To insure its safety as a human food two procedures of con- 
trol are necessary. 

First. — By inspection of cattle, methods of production and 
transportation, secure a supply that is pure, clean and fresh. 

Second. — By the application of heat, destroy all disease 
germs that may be in it, whether, they come from animal or 
human sources. 

There are two methods of disinfection by heat in common 
use: (a) complete sterilization by boiling, and (6) partial ster- 
ilization, "pasteurization," by heating the milk to between 140° 
and 150° F. for from twenty to thirty minutes. 

Both of these methods are effective. The partial steriliza- 
tion, "pasteurization," seems to have fewer objectionable fea- 
tures, and is already established in this country as an accepted, 
successful process. 

To obtain the most perfect results market milk, intended for 
human consumption as milk, should be pasteurized under the 
control of central authority and in the final container. 



190 



PART VI. THE GRADING OF MILK. 



A. GENERAL DISCUSSION. 

It is the prevailing opinion of those who have made a study 
of the subject that milk should be graded, although it is evi- 
dent that the ideal system has not yet been devised. The 
system should aim, first, to aid in the production and distribu- 
tion of milk which is safe from a health point of view, and 
which is of varied chemical composition. 

The present Massachusetts statute contemplates to a slight 
extent the latter consideration by establishing a minimum stand- 
ard of 12.15 per cent, for solids and 3.35 per cent, for fat, and 
the constitutionality of this type of statute has been repeatedly 
upheld by the Supreme Courts of this and other States on the 
ground that it is a health law. The courts recognized the fact 
that the milk of many cows did not come up to the standard, 
but were of the opinion that the people should be protected from 
an impoverished food. As a rule, where a minimum standard 
is established the quality of the milk adapts itself to the standard. 
Massachusetts, however; is an exception to this rule. The fig- 
ures obtained from the samples collected by the inspectors of 
the Massachusetts State Board of Health show that the average 
milk sold in this State is 4.5 per cent, above the standard for 
solids and 14.6 per cent, above the standard for fat. The dis- 
crepancy is due to the fact that only a sample of skimmed 
milk can literally comply with the standard. 

The following table shows the average composition of milk 
not declared adulterated, which has been collected and exam- 
ined by the Massachusetts State Department of Health. 



Yeak. 


Number 

of 
Samples. 


Solids. 


Fat. 


Solids 
not Fat. 


1909, 


4,242 


12.78 


4.10 


8.68 


1910 


5,032 


12.85 


4.02 


8.83 


1911 


4,341 


12.83 


4.00 


8.83 


1912 




12.66 


3.89 


8.77 


1913 


6,154 


12.69 


3.84 


8.85 


1914, 


5,502 


12.70 


3.82 


8.88 


1915, 


6,765 


12.68 


3.82 


8.86 



191 

Commercial grading of milk is to some extent practiced thus: 
Many dealers sell milk of different fat content, charging dif- 
ferent prices, and others sell one grade of milk, charging a 
higher price than the usual commercial price by reason of its 
high fat content. No attempt, however, seems to have been 
made at official supervision of the sale of milk upon its chem- 
ical composition other than the necessary establishment of mini- 
mum standards. 

Attempts have been made by different cities and towns to 
control the sanitary condition of milk by fixing by regulation 
a maximum bacteria content above which the milk cannot be 
sold. This is true of many cities and towns in Massachusetts, 
but beyond a few warning letters and some newspaper pub- 
licity but little attempt seems to have been made to strictly 
enforce these regulations. 1 

Standards of this sort are not to be construed as grading, 
because they are applied to the milk intended for use by the 
ultimate consumer, and the retail or wholesale dealer can easily 
devise means of controlling the final product by proper selec- 
tion of milk in the one instance and by pasteurization in the 
other. The contractor will buy high-grade and low-grade milk 
at the same price, and by mixing these various grades of milk 
the fat and solid content of the mixture will more or less con- 
form to the standard. The producer under these circumstances 
is paid by the quart, irrespective of the fat content of the milk, 
or, if any change in price is made, it is liable to be a reduction 
in the case of the low-grade milk. The contractor will also 
buy indiscriminately clean and dirty milk, and will mix, clarify 
and pasteurize it, thus giving no incentive to the farmer to 
produce clean milk. 

There seems to have been no attempt made on the part of 
any State to establish and control the grading of milk, but the 
cities in New York State, under the provisions of the sanitary 
code of the New York State Department of Health, areat- 
tempting to do so. New York City, however, under the author- 
ity of the City Health Department, is maintaining successfully 
a grading system, based upon the bacterial content, whereby 
both the producer and the consumer are adequately compen- 
sated and protected. This system, which can be easily con- 

i Brockton is a notable exception to this statement. 



192 

trolled when dealing with a congested population, prohibits the 
sale of raw milk unless of a quality resembling certified milk. 
This milk must be below a maximum bacterial content, must 
be obtained from tuberculin-tested cattle which are housed in 
stables of a minimum score on the special score card designed 
by the Department. All other milk must be pasteurized in 
apparatus approved by the Health Department, and in making 
the pasteurization regulations the commission has devised the 
scheme which makes the system a success, — by appealing to 
the commercial instinct of the dealers. If the bacterial content 
of the raw milk is above a certain fixed maximum this milk 
cannot be pasteurized and sold unless labeled "Grade C, for 
Cooking Purposes Only." In order to avoid the degrading of 
his product the contractor must select his dairies carefully, must 
pick out dairymen who furnish clean milk of a low bacterial 
content, and, in order to obtain sufficient milk to satisfy the 
demands of the retail trade, must pay more money to the 
dairymen furnishing such milk. Another important feature of 
this system is the regulation regarding two grades of pasteur- 
ized milk. The Grade A pasteurized milk is obtained from 
better stables and has a lower bacterial content before pasteur- 
izing than the Grade B milk, and the public is willing to pay 
a higher price for the Grade A pasteurized milk. The sales 
of this grade are said to be increasing, and in order to comply 
with the demand the dealers made it a financial object for 
dairymen to produce milk of the Grade A quality of pasteuri- 
zation. 

The commercial pasteurization of milk should be inspected 
and carefully controlled by the health departments. Notwith- 
standing the fact that modern methods of pasteurization render 
milk safe, yet it is a fact that pasteurized milk is very easily 
contaminated, and after such contamination the growth of the 
bacteria is more rapid than in the case of raw milk less than 
twenty-four hours old. The reinfection of pasteurized milk can 
take place by means of a dirty cooling apparatus, dirty air in 
the cooling and bottling rooms, dirty bottles and dirty help. 
A man sick with typhoid fever working in a milk-bottling room 
can cause as much if not more damage than if he were on a 
farm engaged in milking cows. An occasional visit on the part 



193 

of the health authorities, with a thorough bacteriological exam- 
ination of the milk in all stages of the process, will tend towards 
a safer milk supply than uncontrolled commercial pasteuriza- 
tion. 

The pasteurization of milk should be permitted but once, in 
order to render the process entirely a health measure instead 
of being largely a commercial measure. This will insure the 
sale of milk of near-by production and milk not too old for 
consumption. The application of pasteurization was primarily 
designed in the case of milk for commercial purposes in order 
to enable dealers to market milk which, owing to age, could 
not otherwise be done. It should now be regarded as a neces- 
sary health measure, and its application be carefully studied 
from this standpoint rather than from a standpoint of pure 
commercialism. 

Wherever milk is bought upon a fair equitable price based 
upon the fat content the producers invariably breed cattle 
giving milk with a high fat content, probably due to the fact 
that they receive more money per cow than if the milk is 
bought upon a flat rate per pound or per quart. It seems fea- 
sible that this system should be extended to selling at retail, 
and it would result in the paying of a higher price on the part 
of the consumer for high-grade milk, and, on the other hand, 
would encourage the sale of milk of a low fat content to those 
who could not afford to pay the higher price of milk high in 
fat. Under these conditions there would be a greater consump- 
tion and less waste than at present of that valuable food, — 
skimmed milk. Grading of this sort could be carried out only 
after repealing the skimmed milk law and permitting the sale 
of mixtures of skimmed milk and cream in all proportions, pro- 
vided that the customer is aware of the fact and the per cent, 
of fat is stated upon each container. This is to some extent 
illegally practiced by many' dealers who mix skimmed milk 
with high-grade whole milk for the purpose of producing a 
product but slightly above the standard, which form of adul- 
teration if skillfully done may escape detection upon chemical 
analysis. This process, while reprehensible when applied to 
milk bought and sold by volume, is unobjectionable if the 
purchase and sale were based entirely upon the fat content. 



194 

If a grading system of this sort were instituted, the present 
standards of solids and fat should not apply to milk if the 
containers were labeled with the fat content, if (1) the milk 
were free from added water, and (2) if it complied with a mini- 
mum solids not fat standard based on a sliding scale of 8.7 per 
cent, in skimmed milk or milk with per cent, fat, and of 0.0 
per cent, in a hypothetical milk with 100 per cent. fat. 



195 





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197 



Table II. — Comparison of Prices and Values of Milk, Shimmed Milk 

and Cream by Various Methods of Computation. 

Skimmed Milk. 







+3 i-H 


, 


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, 




i 




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158 


1.0 


1.7 


l.Oi 


2.0 


2.02 


2.8 


2.0 


4.6 


2.5 


5.9 


1 


203 


1.6 


2.2 


1.7 


2.5 


2.9 


3.6 


3.8 


5.9 


4.1 


7.6 


2 


229 


2.2 


2.5 


2.5 


2.9 


3.8 


4.1 


5.6 


6.7 


5.7 


8.6 


3 


262 


2.9 


2.8 


3.2 


3.3 


4.7 


4.6 


7.4 


7.6 


7.3 


9.8 



TF/ioZe Jlf ilk. 



4 


316 


3.53 


3.5 


4.0 


4.0 


5.6 


5.6 


9.2* 


9.2 


8.9 


11.8 


5 


369 


4.1 


4.1 


4.7 


4.7 


6.5 


6.5 


11.0 


10.7 


10.5 


13.7 


6 


421 


4.7 


4.7 


5.4 


5.3 


7.4 


7.5 


12.8 


12.3 


12.1 


15.7 


7 


470 


5.3 


5.2 


6.2 


6.0 


8.3 


8.3 


14 .'6 


13.7 


13.7 


17.5 



Cream. 



8 


488 


6.0 


5.4 


6.9 


6.2 


9.2 


8.7 


16.4 


14.2 


15.3 


18.5 


9 


526 


6.6 


5.8 


7.7 


6.8 


10.1 


9.3 


18.2 


15.3 


16.9 


19.6 


10 


567 


7.2 


6.3 


8.4 


7.2 


11.0 


10.0 


20.0 


16.5 


18.5 


21.1 


15 


769 


10.3 


8.5 


12.0 


9.7 


15.5 


13.4 


29.0 


22.4 


26.5 


28.7 


20 


972 


13.4 


10.8 


15.8 


12.3 


20.0 


17.2 


38.0 


28.2 


34.5 


36.2 


25 


1,176 


16.5 


13.0 


19.5 


14.8 


24.5 


20.8 


47.0 


33.2 


42.5 


44.0 


30 


1,378 


19.6 


15.2 


23.2 


17.5 


29.0 


24.4 


56.0 


40.0 


50.5 


51.6 


35 


1,579 


22.7 


17.4 


26.9 


19.9 


33.5 


28.0 


65.0 


45.8 


58.5 


59.1 


40 


1,783 


25.8 


19.7 


30.5 


22.5 


38.0 


31.5 


74.0 


51.7 


66.56 


66.5 


45 


1,985 


28.9 


21.9 


34.3 


25.0 


42.5 


35.0 


83.0 


57.7 


74.5 


74.0 


50 


2,188 


32.0 


24.3 


38.0 


27.6 


47.0 


38.7 


92.0 


63.7 


82.5 


81.0 


55 


2,390 


35.1 


26.5 


41.7 


30.3 


51.5 


42.4 


101.0 


69.6 


90.5 


89.2 


60 


2,593 


38.2 


28.7 


45.4 


32.8 


56.0 


45.9 


110.0 


75.4 


98.5 


96.6 



1 Purchasing prices of Turner Centre Dairying Association. 

2 Selling prices of Turner Centre Dairying Association. 

* Boston contractors pay from 3 to 3.5 cents per quart for milk. 

4 Retail price of milk, 9 cents per quart at 3.7 per cent. fat. 

1 Retail price of cream, 60 cents per quart, at 30 to 40 per cent. fat. 



198 

Under such a grading system the price could be established 
in a manner similar to that now employed by the Turner 
Centre Dairying Association, — by paying a flat price per quart 
plus the value of the butter fat at an established price per 
pound. 1 The tables on pages 195 and 197 show the composition 
of skimmed milk, milk and cream, its food values in calories 
per pound, its cost and selling price calculated as described 
above, and its monetary value at a definite price per calorie. 
The data from which the composition of the milk has been 
computed can be found in the reports of the analyst of the 
Massachusetts State Board of Health, 1907-14. Judging from 
these computations and the data obtained from milk producers, 
the Boston milk contractors are buying butter fat from the 
farmer at about 31 cents per pound, and selling it at about 
85 cents per pound to their retail trade. 

A study of Table II. will show that the prices paid for 
cream are much higher than the increased food value should 
warrant, and that the skimmed milk is far more valuable than 
its market price. At the present price of skimmed milk (2 
cents per quart) cream containing 40, per cent, fat is worth 
22.6 cents per quart, and at the present price of cream (60 
cents per quart) skimmed milk is worth 5.9 cents per quart. 
It is indeed unfortunate in these days of high food prices that 
such a quantity of valuable and highly digestible protein and 
carbohydrate food is wasted, owing to the excessive demand 
on the part of the public for cream. 

The grading of milk by the New York City Health Depart- 
ment has been successfully carried out by limiting the number 
of bacteria before and after pasteurization, and the dealers now 
comply with the regulations without any serious objections; 
but on the contrary, no attempt has been made to establish 
by law or regulation the sale of milk upon its merits according 
to its chemical composition or food value. Any attempt to 
establish the latter form of grading would be in the nature of an 
experiment, but would in all probability be easier of operation 
and control than the bacteriological grading system, because 

1 The Turner Centre Dairying Association in October, 1916, was buying milk or cream at 50 
cents per 100 pounds plus 37 cents per pound of butter fat, and was selling milk or cream at $1 
per 100 pounds plus 45 cents per pound of butter fat. The sale of this milk or cream is almost 
entirely wholesale by this company. 



199 

the wholesale business in milk is now carried on in many places 
by payment upon the fat basis. The public could estimate to 
some extent the difference between different grades by the 
cream line, and furthermore, the fat content is more easily 
and accurately determined than the bacteria content, and is 
not so liable to fluctuation. 

A requirement that all milk should be pasteurized could be 
easily carried on without hardship in but few cities and towns 
in Massachusetts, notably Boston, Cambridge, Somerville, 
Everett, Chelsea; Revere and Winthrop. Outside of these 
localities, with but few exceptions, the bulk of the milk sold 
is raw milk, and is sold by small dealers, many of whom own 
their own cows and market their own and their neighbors' 
milk. Many contractors in smaller cities do not resort to pas- 
teurization, since their milk comes from near-by cities and 
towns, and pasteurization is therefore not a commercial neces- 
sity, and for them it would in many instances be an expendi- 
ture unwarranted from a commercial standpoint by the size of 
their business, although public health might warrant its appli- 
cation. The most efficient pasteurization from the commercial 
standpoint is the continuous process in which, by the holding 
system, it is necessary to have sufficient milk to take at least 
thirty minutes in flowing past a given point in the apparatus. 
The flash process can be operated with a smaller quantity of 
milk, as it requires but fifteen to forty-five seconds for the 
milk to pass from the mixing tank through the heater, over 
the cooler to the bottles. This process, while more expensive 
to operate because of the higher temperature to be attained, 
however, is open to the objections that the tubercle bacillus 
may not be killed in the short time it is exposed to the heat. 
It is, however, very efficient in reducing the number of bac- 
teria, and causes no coagulation of the milk albumin. 

The prohibition of the sale of raw milk from other than 
tuberculin-tested cattle could not be put into immediate opera- 
tion in Massachusetts without causing a milk famine for a 
time at least, as undoubtedly 90 per cent, of the Massachu- 
setts dairies supply milk from cows not so tested. The dairy 
scores of the Massachusetts State Department of Health ob- 
tained during 1913, 1914 and 1915 substantiate this statement 



200 

as do the data furnished by the State Department of Animal 
Industry; in fact, the figures furnished for 1915 indicate a 
much smaller percentage of tuberculin-tested cattle in Massa- 
chusetts than during 1914. 

A requirement that all raw milk sold in Massachusetts should 
come from dairies with a relatively high score on the United 
States score card would put 50 to 60 per cent, of the milk pro- 
ducers out of business, and would cause a milk famine in all 
places other than large cities and towns where the sale of pas- 
teurized milk is the rule, and would play directly into the hands 
of the large dealers. It is possible, however, to devise a modi- 
fied score card where great stress is laid upon methods and less 
upon equipment than in the present score card. 

If grading were entirely a matter of local option its adoption 
and operation would probably be carried on as extensively in 
the future as at present, since each city and town can now 
adopt such a system under chapter 744 of the Acts of 1914, 
and none have seen fit to do so. The local adoption of such 
a system in Massachusetts would lead to serious disturbances 
among dealers who sell the same product in several towns, and 
it would result in selling elsewhere the milk too poor to conform 
to the requirements of certain localities. The cost of operating 
the system would be so high that many cities and towns would 
be unable to enjoy its benefits. Such a system should be en- 
acted by statute, and should be enforced by a central authority, 
■ — the. State Health Department, — since the system has as 
its prime motive the health of the people. 

B. RELATION BETWEEN SOLIDS AND FATS IN MILK. 

The chemical analyses of milk made by the analysts of the 
Massachusetts State Department of Health have shown that 
a fairly definite relation exists between the percentage of solids 
and of fat. If in the average sample the per cent, of fat is 
much higher than the normal fat corresponding to the solids the 
sample is probably watered, and if much lower, the sample is 
probably skimmed. The greater the difference between the 
normal fat and the fat determined upon analysis the greater 
the probability of adulteration. The State Department of 



201 

Health has collected and examined during the past nine years 
1,000 samples of milk of known purity from individual cows; 
that is, these cows were milked in the presence of an analyst 
or inspector of the State Department of Health, the milk of 
each cow was thoroughly mixed, and a sample was taken and 
examined in the laboratory. These analyses were made for 
the purpose of ascertaining the minimum percentage of ingre- 
dients below which milk could be declared adulterated; there- 
fore the majority of the samples were taken from cows giving 
a heavy flow of milk and from those breeds known to give 
relatively poor milk. The relation between the solid and the 
fat content of the samples has been determined for each 0.1 
variation of solids between 10 and 16 per cent., and for each 
0.1 variation of the fat between 2.4 and 6.4 per cent., from 
which relation the average solids and fat for each 0.1 variation 
of either ingredient has been calculated. This table is too 
bulky for insertion, and a summary has been made and is 
presented herewith. 

During the year 1913 the Department collected and exam- 
ined 6,044 samples of commercial milk which could not be 
declared adulterated by the methods of analysis employed. The 
relation between the solids and fat content of these samples 
was determined in a similar manner to that employed with 
the known purity samples. The summary of this table is 
presented herewith. 



202 



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203 



After the averages had been computed it was found that the 
known purity samples up to 14.7 per cent, solids were rela- 
tively higher in fat than the commercial samples, but above 
this percentage of solids were relatively lower. The detection 



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of skimming is difficult when the fat content is between 3 and 
5 per cent., and the differentiation between milk and cream 
is difficult when the fat content is between 5 and 7 per cent. 
These two conditions probably account to some extent for the 
difference between the two sets of averages. The curve of the 
average solids and fat is shown in the above chart. 



204 



At the request of Prof. George C. Whipple these analyses 
were plotted upon the arithmetic probability scale of Hazen 
and Whipple. The percentages are so arranged upon this scale 



P£RCEMT OF /A/GRED/£NT& 




that if the data are obtained in sufficient quantity, and the 
variable follows the law of probability, the resulting curve will 
be a straight line. While the lines obtained in these instances 
are not straight, they are so nearly straight that we are jus- 



205 

tified in assuming that sufficient samples have been examined 
from which definite conclusions can be drawn. 

In the probability chart presented herewith the abscissae 
(horizontal dimensions) represent the per cent, of samples, and 
the ordinates (vertical dimensions) represent the maximum per- 
centage of ingredients. For example, 20 per cent, of the known 
purity samples contained less than 11.6 per cent, solids, 3.3 
per cent, fat and 8.2 per cent, solids not fat. Twenty per cent, 
of the commercial samples contained less than 1.1.9 per cent, 
solids,. 3.1 per cent, fat and 8.29 per cent, solids not fat. Not- 
withstanding the fact that the solids were higher by 0.3 in the 
commercial samples, the fat was lower by 0.2, a difference of 
about 7 per cent, in the total fat content. Forty per cent, of 
the samples in each instance contained less than 12.35 per cent, 
solids, the known purity samples containing less than 3.7 per 
cent, fat, and the commercial samples containing less than 3.3 
per cent, fat, a difference of 0.4, or about 11 per cent., of the 
total fat content. 

Under the assumption that the average commercial samples 
should contain the same average fat as the known purity 
samples of the same total solids content, the per cent, of fat 
corresponding to the per cent, of solids has been calculated and 
inserted in the chart as a dot and dash line, and the space be- 
tween the calculated and found fat percentages has been cross- 
hatched in order to emphasize the deficiency in fat of the com- 
mercial samples. When the fat exceeds 5.2 per cent., however, 
the commercial samples have a higher fat content than those 
of known purity, probably because samples of low-grade cream, 
claimed by the dealer to be milk when the inspector took the 
samples, are included in this portion of the chart. These sam- 
ples, however, are less than 1 per cent, of the total number. 

Ninety-nine per cent, of the average samples had less fat than 
would be expected if they are judged by the average quality 
of the 1,000 samples of known purity. 



206 



PART VII. EXPERIENCES OP OTHER LOCALITIES. 



A. REPORT ON AN INVESTIGATION OF THE NEW YORK 
CITY MILK GRADING SYSTEM IN THE CITY OF NEW 
YORK. 

On October 4 representatives of the State Department of 
Health visited the Department of Health of the city of New 
York, and saw Mr. Lucius P. Brown, chief of the Division of 
Foods, and Mr. Russel Sturgis, director of the Milk Inspection 
Department. 

The present system of milk grading in New York City has 
been in operation for nearly three years, and is meeting with great 
success and producing good results. There are four grades : — 

Grade A, { ." . , 
' [ pasteurized. 

Grade B, pasteurized. 

Grade C, pasteurized. 

All these grades must be properly labeled, and Grade C must 
be labeled "For Cooking Purposes Only." Milk can be pas- 
teurized only once. The Grade A raw milk is substantially 
the same as certified milk. The Grade A pasteurized milk is 
of the same quality as Grade A raw milk, except the cows need 
not be tuberculin tested. The Grade B raw has been discon- 
tinued. The following table shows the grading system practiced 
in New York City: — 

Grade A. 

1. Raw. 

Dairies: — 

Equipment, 25 

Methods, 50 

Bacteria: — ■ 

60,000 per cubic centimeter. 

2. Pasteurized. 

Dairies: — 

Equipment, 25 

Methods, 43 

Bacteria: — 

200,000 per cubic centimeter before pasteurizing. 

30,000 per cubic centimeter after pasteurizing. 



207 



■ Grade B. 
Pasteurized. 
Dairies: * — 

Equipment, 20 

Methods, 35 

Bacteria : — ■ 

1,500,000 per cubic centimeter before pasteurizing in city. 
300,000 per cubic centimeter before pasteurizing in country. 
100,000 per cubic centimeter after pasteurizing. 

Grade C. 
Pasteurized. 
Dairies: — 
Total, 40 

Bacteria : — 
300,000 per cubic centimeter. 

If milk does not comply with the requirements of the rules 
and regulations it may be degraded. One of the principal fea- 
tures of this system is the requirement that milk containing 
more than a maximum of bacteria shall not be pasteurized. 
This makes it incumbent upon the milk dealer to see that the 
farmer is careful in milking, and that he cools the milk and 
delivers it as soon after milking as possible. A vast majority 
of the Grade B sold in New York City reaches the consumer 
not more than thirty-six hours old. 

For the control of pasteurizing plants 18 country inspectors 
are employed and three city inspectors. These numbers vary 
from time to time. Each pasteurizing plant is supposed to be 
covered once per month, the inspector taking from 16 to 30 
samples in each plant. He carries a special ice box in which are 
placed 1-ounce vials with a screw-capped metal cover, and carries 
a bundle of sterilized aluminum pipettes about 2 feet long. 

In the ordinary inspection of a pasteurizing plant the in- 
spector takes 4 samples from the mixing vat, 4 from the out- 
let of the holding tank, 4 from the outlet of the cooler, 4 from 
the bottles ready for shipment. The time the samples are 
taken is noted upon the sheet, and also the temperature of 
the milk and the bottle number. Under extraordinary con- 
ditions samples are also taken from the outlet of the clarifier, 
from the outlet of the heater, and, if more than one holding 

1 At present not enforced. 



208 

tank is employed, from each of the several tanks. The in- 
spector, furthermore, makes a record upon a separate sheet of 
the name of the pasteurizing plant, the character of the pas- 
teurizing apparatus, the temperature to which the milk was 
heated, the length of time it was held, the temperature of hold- 
ing, the temperature at which it was received, and the tem- 
perature to which it was cooled. The bottles and cards con- 
taining the original data of collection are then transported 
either in person by the city inspectors, or by express by the 
country inspectors, to the bacteriological laboratory. From the 
samples taken from the mixing vat two dilutions are made — ■ 
1-100 and 1-10,000 — and a composite sample is taken for the 
isolation of the colon bacillus. The samples of heated milk 
are plated from dilutions of from 1-100, and the colon bacillus 
is isolated from the sample from the holder. In addition to 
this a sample of the water is sometimes taken, and a sample 
of can rinsings and bottle rinsings. For this latter purpose 
the inspector carries a bottle containing 50 cubic centimeters of 
sterile water. The contents of these bottles are poured into a 
bottle or can which is thoroughly shaken and the liquid returned 
to the original bottle. These samples are plated straight and 
1-100 dilution. The results of the 4 samples are averaged, and 
the average figure taken upon which to base the opinion of 
the conditions at the plant. 

The Department permitted access to the records, and the 
results of 50 inspections were copied, omitting, however, the 
name of the dealer. The following are characteristic results 
from pasteurizing plants operated under good conditions and 
under poor conditions : — 

Plant operated under Good Conditions. 



Chabactek of Milk. 



Bacteria 
per Cubic Centi- 
meter. 



Raw, 

At various stages of pasteurization: — 
From outlet of holding tank, 
From outlet of cooler, . 
From cans 



124,5001 

2,700 2 

275 
1,975 



1 Colon bacillus present in dilution of 1-100. 

2 Colon bacillus not present in 4 cubic centimeters. 



209 
Plant operated under Poor Conditions. 



Character of Milk. 



Bacteria 
per Cubic Centi- 
meter. 



Raw, 

At various stages of pasteurization: ■ 
From outlet of pasteurizer, . 
From outlet of holding tank, 
From outlet of cooler, . 
From cans, 



18,850,0001 

15,000,000 

100 

15,000 

60,000 1 



1 Colon bacillus present in dilution of 1-10,000. 

The dealer was notified to label this product Grade C. 

The bacteriological laboratory makes 300 bacteria counts per 
day. The work is done by 8 women who are paid about $40 
per month each. They work under the direction of a woman 
who is a competent bacteriologist and doctor of medicine. She 
has nothing whatever to do with the reporting of the results to the 
milk dealers, and gives out no information regarding the work. 
The women who do the actual work are divided into two 
groups. They plate samples upon one day and count upon 
the next day, and the work is so arranged that if one of them 
is sick another can take her place. A large clerical force is 
used to compile the results. Dealers are not prosecuted, and 
in general a threat to degrade the milk is sufficient to induce 
the dealer to locate the trouble and make the necessary cor- 
rections. 

On October 5 a commercial laboratory in New York City 
was visited, and the secretary and the director were interviewed. 
Inquiries were made regarding the practical application of the 
New York grading system. Both men were of the opinion that 
the system is. all right, provided the regulations are reasonable. 
They criticized the recent regulations requiring milk dealers to 
sell milk containing not less than 8.5 per cent, solids not fat. 
They stated that grading had come to stay, but the ideal sys- 
tem had not yet been devised. The present conditions are 
infinitely better than former conditions, and no person would 
care to go back to the old system. This laboratory does a 
large amount of work for commercial milk dealers, and its 



210 

opinions would naturally be somewhat antagonistic to the 
Department of Health of New York City. 

A milk contracting company was visited, and the chief veter- 
inarian and a member of the sales department were interviewed. 
The veterinarian stated that the company maintained 11 veter- 
inary inspectors and a local inspector at each country pasteur- 
izing plant. The veterinarians make systematic visits to the 
dairies, each dairy being visited on an average of every six to 
eleven months. The local inspectors situated at the pasteuriz- 
ing plants are expected to visit each dairy at least every month. 
These visits are made for the purpose of seeing that the cattle 
are healthy, as tuberculin testing is required for the sale of 
Grade A raw milk, but on the average more for the purpose 
of seeing that the dairies are kept in such condition that the 
raw milk will fall below the maximum bacteria requirement, 
above which it cannot be pasteurized without being degraded. 

The company purchase milk upon the fat basis, but they 
sell their milk by the quart. On inquiring the reason for this 
difference the representative of the company stated it was nec- 
essary to do so in order to obtain milk of sufficiently high fat 
content so that it could be sold in New York without violating 
the requirements of the Department of Health. It also en- 
couraged the production of high-grade milk and discouraged 
the production of butter on the farm. Shortly after they began 
to pay for milk upon the percentage of butter fat it contained, 
one farmer stated that he purchased butter for the first time 
in eleven years. The result of this method of buying has in- 
creased the quality of milk which the company have obtained 
from the farmers, because they are getting all the cream given 
by the cows. The milk is sold by the quart, the prices vary- 
ing according to the bacteriological grades of the New York 
City Department of Health. 

When asked whether or not the people of the city of New 
York appreciated the grading system, it was stated that the 
increase in the sale of Grade A pasteurized milk had been so 
rapid that they could not obtain caps for the bottles fast 
enough from the manufacturers; 

In answer to an inquiry as to whether or not they had any 
trouble with the city Department of Health regarding the oper- 



211 

atioji of the rules and regulations, it was stated that the com- 
pany had no trouble with the Department of Health in any of 
their country pasteurizing plants. 

The company stated that they began inspection work before 
the New York City Department of Health started the grading 
system. They are of the opinion that the dealer should be 
regarded as a factor in milk production, and be given proper 
recognition; and the larger the dealer the better for both the 
producer and the consumer. There is considerable competition 
between dealers in the producing territory, and this statement 
was confirmed by others. If the dairymen are all producing 
milk of good quality they will sell at the best prices. Naturally, 
the largest dealers will get the best retail trade, have less bad 
bills, and can therefore afford to give the most money for the 
raw milk and pick out the best dairies. The chief veterinarian 
of the company was of the opinion that the farmers under the 
best circumstances could not go into the retail milk business 
and make a profit. The sales manager stated that he was of 
the opinion that Massachusetts milk contractors did not in- 
spect their dairies, and he knew that one Massachusetts com- 
pany made no dairy inspection in the buying districts where 
they came in competition with the New York company. This 
was confirmed by a statement made by one of the New York 
City inspectors, that the dairies which were rejected by the 
New York company were accepted by the Massachusetts com- 
pany. Both representatives of the New York company were of 
the opinion that grading has come to stay and will be extended. 

They were asked regarding the grading of milk in cities in 
New York State other than the city of New York, and stated 
that the grading law, with a very few exceptions, would not 
be enforced by small local boards of health. These local boards 
of health made regulations which were not reasonable, by reason 
of the fact that they knew nothing about the business, and 
most boards would not enforce a grading law by reason of the 
fact that they had no money to do so, or did not care to insti- 
tute any complaints against their neighbors. When asked what 
was the smallest possible quantity of milk which could be pas- 
teurized without pecuniary loss neither man cared to give an 
opinion. . 



212 

Another company was next visited, and the manager -was 
interviewed. He stated that in his opinion the grading system 
was all right, but the regulations should not be changed quite 
so frequently. New regulations caused considerable trouble to 
the dealer, who would naturally purchase a large stock of caps 
for the milk bottles, and under changing regulations many of 
these caps became obsolete, and therefore had to be destroyed. 

He believed the grading system is a good thing, and should be 
encouraged, but other communities should follow the New .York 
City system as closely as possible, in order to obtain uniformity in 
methods of production and distribution. He was of the opinion 
that the public did not appreciate the grading system as it 
should, and bought milk upon the recommendation of other 
people, or of their family physicians, and in general bought the 
grade most suited to their means. 

An assistant manager of this company stated that when the 
grading system was first established it was regarded by the 
dealers as an imposition. At present he has no objection to 
the system as a whole, but does object to the changes in the 
regulations, specifically the recent regulation requiring a mini- 
mum solids not fat of 8.5 per cent. He stated that some local 
regulations, specifically those of Buffalo, were more rigid than 
the New York City regulations, but in general, outside of the 
city of New York, little attempt was made to grade milk in 
New York State. 

This company employ 11 inspectors, 3 of which are veteri- 
narians. They spend their entire time in inspecting dairies, and 
each man inspects about 300 per month. The cost to the com- 
pany is about $25,000 per annum, of which $15,000 is for 
salaries. The reason for the low expense account is due to the 
fact that the men live in their inspecting territory, and travel 
around by- means of automobiles, which they own, the main- 
tenance of which is paid by the company. The assistant man- 
ager thinks this is better than the other systems of inspection, 
where local inspectors are employed in the forenoon as can 
receivers and in the afternoon as inspectors. He believes that 
acting in the former capacity is beneath the dignity of an in- 
spector, and the dairymen look upon it in this way; but when 
a man is inspecting all the time he commands the respect of 
the farmers. They buy milk upon the bacterial content and 



213 

upon the fat per cent. He thinks that the board of health 
should score the milk, and not the dairy. 

This company also purchase small-top milk pails by carload 
lots, and sell them to their dairymen at cost price, which 
amounts to about 75 cents per pail. The inspectors, however, 
find that the farmers are often very lax in the use of such pails. 
A copy of a chart was furnished showing the bacterial content 
of the raw milk received in their New York pasteurizing plants 
each month during the past three years. This work was done 
by a commercial laboratory, about 10,000 samples being exam- 
ined each year. The figures for 1914 are considerably below 
those obtained in 1913, and the figures for 1915 are, in all 
cases, below the requirements of the New York City Depart- 
ment of Health for Grade B pasteurized milk. This bringing 
down of the bacteria count was entirely the result of the in- 
spections made and the advice given to the dairymen by the 
company. The assistant manager would not state definitely 
how small a quantity of milk could be pasteurized at a profit. 
He was of the opinion, however, that a dealer could operate 
a single tank set, in which the milk was heated, held and 
cooled, without removal from the tank. 

On October 6 Dr. Hermann Biggs, Commissioner of Health 
for the State of New York, was interviewed. In response to 
inquiries relative to the operation of the grading system in 
New York State, Dr. Biggs stated that the system is working 
as well as could be expected, and a number of cities and towns 
which never had done any milk work were now beginning to 
do some work. The grades are the same as those adopted by 
New York City, but each city or town in the State has the 
right to make rules and regulations which may be more, but 
must not be less, rigid than those of the New York State De- 
partment of Health. Some cities, notably the city of Buffalo, 
have made regulations more rigid than the regulations of the 
State. Dr. Biggs was asked if there were any cities in New York 
State with conditions analogous to those of Boston; where one 
city is making the dairy inspections, and making some attempt to 
control the pasteurizing of milk delivered in eight or ten cities, 
which do practically nothing in the way of milk inspection. 
Dr. Biggs stated there were no such conditions in New York 
State. 



214 



B. REPORT ON A SPECIAL INVESTIGATION OF THE EFFI- 
CIENCY OF THE NEW YORK GRADING SYSTEM IN THE 
PRODUCING AREA. 

Acting on information from the Connecticut Dairy and Food 
Commissioner, that he had heard a rumor that certain milk 
dealers in Connecticut were shipping milk to New York in vio- 
lation of the New York City requirements, one of the analysts 
of the Food and Drug Division, in company with a Connecti- 
cut dairy inspector, investigated a plant shipping milk from 
Connecticut to New York City. The New York City system 
allows pasteurization plants to be licensed and ship milk to 
New York. Some are Grade A plants, which can pasteurize 
and bottle milk which comes up to the New York requirements 
for Grade A only. A Grade A plant cannot bottle milk falling 
below those requirements, and if for any reason any dairy ship- 
ping to such a plant falls to Grade B, the plant is not allowed 
to handle this milk with Grade A, but must ship it in cans as 
"C" milk to New York. In New York such milk can be pas- 
teurized and bottled as Grade B. 

In a similar manner a Grade B plant cannot bottle milk 
under the Grade A cap. Any milk coming to such a plant to 
be pasteurized must come up to the New York requirements 
for Grade B milk. Milk from Grade A dairies, if shipped to 
a Grade B plant, must be put out from such a plant as Grade 
B. The rumor relative to violations of the New York City 
milk rules was that some plants were handling both "A" and 
"B" grades, and it was suspected that some Grade B milk was 
being sent to New York with Grade A caps. 

As far as the Connecticut dairy authorities knew, the only 
plant shipping bottled milk to New York with Grade A caps 
was Borden's Grade A pasteurization plant at Washington, 
Conn. The original plan of inspection was to visit this plant 
and also some of the dairies supplying it, but owing to a heavy 
snow fall a few days before, most of the roads were impassable 
and train service uncertain, so the Washington plant was the 
only place visited. |f 

This plant receives milk from dairies scoring high enough to 
furnish Grade A under the New York requirements. These 



215 

dairies are scored twice a year by agents of the New York City 
Board of Health and by Borden's inspectors about once a 
month. Sediment tests are taken frequently at the plant so 
that the farmer can see how his milk compares with that of 
his neighbors. The investigators saw about 20 sediments from 
these tests, and all were unusually clean, some showing no sedi- 
ment whatever. Samples are taken for butter-fat tests every 
day, as the farmer's pay depends on the grade of milk plus 
the amount of butter fat, Grade A milk with 3.80 per cent, 
fat being worth 4 cents per quart. If milk shipped to a Grade 
A plant falls to Grade B requirements, the shipper must either 
accept a Grade C price, which is 10 cents per can less than 
Grade A, or else ship to a plant handling Grade B milk. 

At Washington bottles bearing Grade A caps, and others 
with Grade B caps, were seen which might lead one to believe 
that this plant was violating the regulations by handling milk 
from Grade B dairies. This, however, was not the case, as all 
the milk came from dairies up to the Grade A requirements, 
and could be bottled as Grade A if there were sufficient de- 
mand for this grade, which costs the consumer 1 cent per 
quart more than does Grade B. As there is no regulation for- 
bidding the selling of a high-grade milk in place of a lower one, 
this plant was merely selling its surplus Grade A milk as Grade 
B, for which there was plenty of demand. 

At the plant a record is kept of all milk received, source of 
supply, and amount of bottled milk sent away each day, as 
well as a record of the temperature and time of pasteurization. 
These records are inspected from time to time by the New 
York Board of Health. If these inspections show that milk 
has been received from Grade B dairies, the plant's license may 
be taken away and the milk of mixed grades may be destroyed. 

The manager of the Washington plant thought that the New 
York City system of grading milk was the best one yet devised, 
and that other States and cities would adopt a similar one. 
With proper inspection of the dairies and the records ot the 
plants, there seems to be no reason why a State or city could 
not be reasonably sure of its milk supply. If a contractor 
tried to evade the law and sell low-grade milk for a higher 
one, he would surely be caught in less than a month, and lose 



216 

more than he could possibly gain. The whole system depends 
on proper and frequent inspection by competent men. The 
only possible disadvantage to such a system is that it prac- 
tically forces dairymen to sell at wholesale rates unless they 
can make certified milk. 

C. REPORT ON A SPECIAL INVESTIGATION OF THE NEW 
■ YORK GRADING SYSTEM IN THE PRODUCING AREA. 

On Jan. 14 and 15, 1916, a representative of the Massachu- 
setts State Department of Health visited a number of farmers 
in the vicinity of Utica, N. Y., to get their opinions of the 
present grading system of the New York City Board of Health 
for the milk supply of that city. These farmers deliver milk 
to three different stations, namely, the Muller Company of 
Marcy, N. Y., the Harlem Products Company of Clinton, N. Y., 
and the R. F. Stevens Company of Clinton, N. Y. Two 
of the farmers are grange masters, and most of them grange 
members. They are nearly all making Grade B, but a few 
were making Grade C, milk. None of them were producing 
Grade A milk. 

The prices paid for milk were from $1.70 to $1.80 per 100 
pounds for Grade B milk, and 10 cents per 100 pounds less 
for Grade C. In case of the Stevens station a fat percentage 
of 3.8 was also required for Grade B, as well as Ahe other New 
York City grading system requirements; and 10 cents per 100 
pounds was offered for every .1 per cent, fat over 3.8 per cent. 

The farmers were asked particularly what objections, if any, 
they had to the system; also what they received for their milk, 
and if prices were satisfactory, and if not, what they considered 
fair prices; whether the inspection requirements were consistent 
with the prices allowed; whether the inspection was fair or too 
rigid for the grade supplied; what grade of milk they supplied 
and what determined the grading; if the inducement to supply 
a higher grade was worth the extra effort; whether the in- 
spectors themselves were competent; and finally, whether the 
system was in any way satisfactory to them. Taken individ- 
ually, their statements were as follows : — 

1. Mr. A, Marcy, N. Y. — Mr. A is furnishing Grade C milk. He re- 
ceives $1.70 per 100 pounds of milk. He said he, on the whole, was well 



217 

satisfied; that the treatment of the farmer depended largely on the con- 
tractors; that his station did not pay as well as some others; he did not 
care to retail milk, as customers were uncertain and the station took all 
his product. When asked why he did not get into a higher grade, he said 
the scoring requirements would not put him there, and for the little extra 
he received (10 cents per 100 pounds) it was not worth while. 

2. Mr. B, Marcy, N. Y. — Mr. B is furnishing Grade B milk. He said 
at once that he was very much dissatisfied; that in his opinion the require- 
ments should be for one grade, with all the farmers in that grade. He said 
most decidedly that the price received was not by any means sufficient. 
He receives at present $1.80 per 100 pounds of milk. Prices varied accord- 
ing to season from $1.05 to $1.85 per 100 pounds. When asked what he 
considered a fair price, he said $2 per 100 pounds for the winter months 
and $1.50 for the summer monthswould be satisfactory. He said the slight 
increase in price for milk of higher grade is not enough to make it worth 
while producing it. Some contractors give more than others; the farmer 
is at the mercy of the contractor. The inspectors are not practical men 
and do not understand their work thoroughly. He did not know of a 
good point about the system, and would prefer to retail milk, but had no 
near-by market. 

3. Mr. C, Marcy, N. Y. — Mr. C is furnishing Grade C milk. He 
receives now $1.70 per 100 pounds. When asked why he was in this 
grade he replied that his barn was old and his score did not place him 
higher. He was asked about bacterial count placing him in grade, and 
he said he heard very little of this, and has only received reports of bac- 
terial count twice; but the scoring of his barn was what placed him in 
Grade C, although his milk is clean. He considered that the bacterial 
count is extremely variable and uncertain, and often ran high for some 
unaccountable reason; also thought that scoring and bacterial count were 
not consistent. He said also that he knew that Grade B and Grade C 
milk were lixed at the station; whether it all went out as Grade B he 
was not certain, but it was likely that it did. He considered the inspectors 
not well informed or practical. Slightly rusty utensils were often com- 
plained of, yet rusty and dirty cans often came to him from the station. 
When asked in regard to prices he said emphatically that he did not re- 
ceive enough money; that the price of help is double what it was ten 
years ago, and the price of milk has gone up but 25 per cent.; $2 for six 
winter months and $1.50 for six summer months would be fair prices in 
his opinion. 

4. Mr. D, Marcy, N. Y. — Mr. D is furnishing Grade C milk, and re- 
ceives at present $1.70 per 100 pounds of milk. In his opinion his milk is 
as clean as he can produce it, yet his score holds him in Grade C. He has 
heard but twice reports on bacterial count. The sediment test is taken 
once a week, and he considers this a good requirement. He said, more- 
over, that clean milk could be produced under almost any surrounding 
conditions if cows, utensils and the farmer himself were clean. When 
asked in regard to price he replied that it is not by any means enough; 



218 

the price of raw material, fodder, etc., should be taken into account when 
regulating price allowed for milk. Three and one-half to 4 cents per 
quart is the present cost of producing milk. He considered that the farmers 
are at the mercy of inspectors who do not know their business. He said 
that the farmers are fools to let this system continue, and not make some 
effort in their own united interests. He also knew that Grade B and Grade 
C milk were mixed at the station, and were probably sold as Grade B in 
New York City. 1 

5. Mrs. E, Marcy, N. Y. — Mrs. E is producing Grade B milk, and 
gets $1.80 now per 100 pounds of milk. She said at once that prices were 
not sufficient, and that the difference in price for a grade higher milk is 
not enough to make it worth the extra effort to produce it. The grading 
in her opinion is done entirely by score card, yet she received a report of 
bacteria count once when it ran high, which would perhaps indicate that 
this also has some influence on the grading. She considered the whole 
system in an unsatisfactory condition. A price of $2 per 100 pounds for 
winter months and $1.50 for summer months would be fair. She, more- 
over, intends to make cream from all of her milk and sell this rather than 
sell milk to the station under present conditions. 

6. Mr. F, Clinton, N. Y. — Mr. F sells his milk as Grade B, and all 
milk sold to this station is of that grade. He is graded, as far as he knows, 
according to result of score card rather than bacterial count. He gets at 
present $1.70 per 100 pounds, and has received as low as $1.10 per 100 
pounds. He said that he was not satisfied, and considers that $2 per 100 
pounds for December and January, and $1.80 to $1.90 per 100 pounds the 
rest of the year, would be a satisfactory price. He also said that he had 
heard that farmers in some sections were considering putting up their own 
station owing to low prices received. Mr. F also objected to the return- 
ing of dirty cans from New York City to be washed at the station, rather 
than washing them in New York City. He said they were returned in an 
unusually filthy condition, and had heard also that often garbage, and in 
one instance a dead cat, had been found in one of the empty cans. The 
writer saw no evidence of this, however. Mr. F also sells some of his milk 
at retail in Clinton, N. Y., and finds this method yields him proper returns. 

7. Mrs. G-, Clinton, N. Y. — Speaking for her husband she said he de- 
livers to station, selling on butter-fat basis as well as on grading. She has 
heard him say he is very much dissatisfied with prices and intends selling 
his cows. 

8. H. Farm, Clinton, N. Y. — ■ This farm is producing Grade B milk, 
which is also sold on the butter-fat basis, 3.8 per cent, required and 10 
cents per 100 pounds allowed for every .1 per cent, over this. This farm 
gets now $1.85 per 100 pounds, and is not satisfied with prices, as no profit 
can be made with present cost of labor and feed. Two dollars for six 
months and $1.50 for six months per 100 pounds would be a fair price. 
This farm makes special effort to have a clean stable, yet cannotget into 
Grade A because of rigid requirements. 

1 Investigations made elsewhere show this statement to be absolutely without foundation. 



219 

9. Mr. I, Clinton, N. Y. — Mr. I had gone out of business because 
prices were not sufficient to warrant his selling milk. He said he had fig- 
ured carefully and found that milk could not be produced on a paying basis 
unless $2.25 was received during winter months and $1.75 for the other 
six months per 100 pounds. To quote Mr. I: "When you feel you are 
losing on every quart produced you lack interest and feel antagonized, 
especially when inspectors are visiting. If inspection is rigid, and it is 
right that it should be, the farmer should get a price which is satisfactory. 
The New York Board of Health should regulate price paid to the farmer 
as well as grade the milk, and hold him to the requirements of his grade." 

10. Mr. J, Clinton, N. Y. — Mr. J sells to Stevens station, giving price 
on butter fat as well as on grade. He sells Grade B milk at $1.85 per 100 
pounds (now). He finds it hard, and said others also do, to produce milk 
above 3.8 per cent, fat and get a good quantity of milk. The variance in 
price is not satisfactory, and the price at any time is not sufficient. Two 
dollars in winter and $1.75 per 100 pounds in summer would be fair. Help 
is scarce and labor is, high because hands will not work as many hours as 
formerly. Mr. J also stated that Grades B and C are mixed at the station; 
whether it is all sold as Grade B is not proved. He considered that the 
system is not well supervised at the station. It is his opinion that the 
grading results more from the scoring than on the bacteria count. 

11. Mr. K, Clinton, N. Y. — Mr. K objected to the same price being 
given to farmers whose buildings were in bad condition as to one whose 
buildings are well kept. He sells Grade B milk. At present prices he 
cannot afford to hire help and buy feed; he therefore does all the work 
himself. The cost of feed has made a large advance in the last ten years. 
Mr. K also does not consider it fair to reduce the price in March or April, 
which is done, when it costs exactly as much to feed the cows, and the flow 
of milk is no greater at this season. As an example of the actual profit he 
gets he said it costs him $50 a month to feed 9 cows, and his receipts for 
the sale of milk were $110, not counting the cost of hay which he raised 
himself. If he hired help he would have little profit left from his milk 
business. Mr. K also considered that the requirement for cooling morn- 
ing milk to 60° F. was a hardship for the farmer, as his facilities were not 
as good for cooling as those at the station, especially when the morning 
milk could be taken immediately to the station without cooling. Regard- 
ing the inspectors themselves, he said they are often not practical men. 
He told of one inspector who visited a farm where the cows were in a 
basement not easily found. The farmer found him in the hayloft looking 
for the cows. Naturally, all respect for the inspector was lost at once. 

12. Mr. L, Clinton, N. Y. — Mr. L said at once and emphatically that 
the price received was not sufficient, and that he intended to go out of 
business. He sells Grade B milk. He said there was not enough induce- 
ment to produce better milk. 

13. Mr. N, Clinton, N. Y. — Mr. N is not selling to a station, as he 
found it more profitable to make butter. When asked why some of the 
farmers did not produce Grade A milk he said that the requirements were 



220 

too rigid; even when the stable is clean and produces a very satisfactory 
product, still more is required, and the farmers will not meet the demands. 
He said the butter-fat premiums are not regular and are lowered without 
reason, perhaps due to a large quantity of milk on hand. Tests for butter 
fat made at the station do not always agree with those made by State 
inspectors. 

It appears from the reports obtained from these farmers that 
the main objection regarding the New York City system is one 
of price. They do not get enough money to make the business 
pay. With one exception, the farmers were very much dis- 
satisfied with the system. This man had been in this country 
but a comparatively short time, and was doubtless more easily 
contented, especially with prices, than an American farmer who 
would be in a position for better judgment. They state that 
the requirements, especially for Grade A, are so rigid as com- 
pared with the price offered for the extra effort that they do 
not consider it worth while getting into a higher grade. They 
claim that the inspectors themselves are often not competent, 
or if competent are not practical in their recommendations. 
It further appears from this investigation that there is a dif- 
ference in the price paid for milk of different grades. There is 
no possibility of a producer making a low grade of milk and 
selling it for a higher grade. 

D. COPY OF AN AETICLE BY LUCIUS P. BROWN OF THE 
NEW YORK CITY HEALTH DEPARTMENT. 

Conclusion and Summary. 

1. In a city of large size it is impossible to so safeguard a 
milk supply confined to raw milk only, at any reasonable cost, 
as to insure its absolute safety. 

2. The present system of milk control in New York City 
has justified itself by the absence of any considerable milk- 
borne epidemic of typhoid or other disease within the past two 
years, and by the ease with which any epidemic appearing can 
be now traced and controlled. 

3. The New York system of milk control is necessarily a 
growth of many years, and is a development proceeding pari 
passu with the growth of knowledge in preventive medicine, 



221 

and particularly in knowledge of the principles of pasteuriza- 
tion. 

4. The essential features of the New York City milk control 
system are — 

(a) Pasteurization of all milk except that intended for special 
uses. 

(b) In connection therewith bacteriologic standards properly 
administered. 

(c) The labeling of all packages intended to go to the con- 
sumer. 

(d) Constant inspection and supervision of the pasteurizing 
plants, which is an inspection that it is physically and econom- 
ically possible to make efficient, in direct contrast with the 
attempt to handle an enormously large number of dairies and 
their employees, — a thing which can be done efficiently only 
at prohibitive cost. 

To thoroughly understand the situation in New York City 
a short statement of the problem is desirable. 

This problem is as follows: The control, both chemical and 
sanitary, of a milk supply for a city of about 5,000,000 people, 
with the aim not only of avoiding raising the cost of the milk, but, 
«if possible, of actually extending its use as a cheap and easily 
digested food. Analysis of the milk supply shows that about 
2,750,000 quarts of milk (including ice cream and condensed 
milk) are consumed daily in the city, furnished by 7 States and 
by 2 provinces in the Dominion of Canada. 

It is estimated that about 50,000 dairies, about 440,000 cows 
and about 300,000 people are employed. This milk supply is 
handled in 60 city and 436 country pasteurizing plants, and 
there are 700 shipping stations for milk shipped raw to the 
city pasteurizing plants. The longest haul upon milk coming 
to New York is about 460 miles, and 80 per cent, of it over 200 
miles. 

The machinery at hand for controlling the milk supply is, of 
course, that under the control of the city Board of Health. 
Under the Constitution of New York State, and charter of 
New York City, the ordinances of this Board have the effect 
of laws; its powers are absolute and very broad, being limited 
only by the disposition of the city's financial boards to appro- 



222 

priate the funds necessary for the enforcement of the laws made 
by the Board of Health. 

Following is a statement of the chief successive steps taken 
for the control of New York City's milk supply, which have 
led up to the system now in effect. The first step taken was 
in 1873, when "swill" milk was forbidden. In 1876 a code 
section was passed by the Board of Health forbidding watered 
milk. In this control, however, only the well-known lactometer 
of the New York City Board of Health was used. The pro- 
ducers finally learned how to beat this lactometer, and in 1895 
chemical standards were set. 

In 1897 a permit system was inaugurated for wagons and 
milk stores. In 1900 the cooling of milk in transit was begun, 
and there has been progressive improvement in this particular 
feature since that time. In 1902 one milk inspector was sent 
to the country to examine the sources of supply. In 1904 the 
milk inspection work, which was formerly done by the separate 
boroughs, was centralized in the hands of the city Board of 
Health, and a regulation was made that all milk must be kept, 
while in process of shipment or sale, at a temperature not greater 
than 50° F. In 1905 a systematic inspection of creameries was 
begun, and certain deficient ones were forced out of business. , 
In 1906 the two inspectors then at work began the inspections 
of the dairy farms proper, and 16 new inspectors were added. 
Rules and regulations for the guidance of dairymen were made; 
and these appear to have been very well received by the dairy- 
man, because of the help it gave him in regulating his own 
business. In 1907 a beginning of the exclusion system was 
made, the requirements being that weekly reports be made by 
creamery men and dairymen of contagious diseases occurring 
in their establishments, and they were required to cease han- 
dling their milk on occurrence of any such diseases. Failure 
to ' comply with this regulation meant the exclusion of their 
milk from the city. This principle was afterwards applied to 
other conditions. Milk stores were likewise regulated as to 
sanitary condition, and the score card system was adopted. 
A notable occurrence during this year was the appointment 
of the McClellan Commission of Physicians, in the report of 
which it was recommended that 100 country and 40 city in- 



223 

spectors be appointed. It will be noted that up to this time 
all the regulations were designed towards the securing of a sat- 
isfactory raw milk supply. In 1908 the first notice in the way 
of an official pasteurization was made. This regulated pas- 
teurization, which had to be conducted under permit. During 
the same year the exclusion system was extended to unsani- 
tary conditions at the creameries and dairies, and the wagon 
permits were made conditional on satisfactory report of con- 
ditions of production and distribution. Likewise in this year 
the classification of milk appears to have been first made. It 
was graded into selected, inspected, guaranteed and certified, 
all conditioned on inspection by medical societies and in ac- 
cord with regulations of the Board of Health, taking cogni- 
zance of conditions of the cows, bacterial count, time of deliv- 
ery, etc. Pasteurized milk was allowed to be sold under permit, 
and there were supplementary regulations on pasteurization 
passed. 

The most notable occurrence of this year was the require- 
ment that there should be attached to the container which 
reached the consumer, or from which the consumer, in the 
case of loose milk, was served, a tag indicating the location of 
the dairy or creamery and the date of shipment. In 1909 pas- 
teurized milk was defined, and it was provided that the tags 
above mentioned must be kept for two months. 

It will be noted that still up to this time little notice had 
been taken of pasteurization, but in 1910 a Board resolution 
(not having the direct effect of law) was passed, advising the 
public that all milk for drinking should be either boiled or 
pasteurized, and a tentative plan for grading was made based 
on the broad division of — 

(a) Milk for infants to drink. 

(b) Milk for adults to drink. 

(c) Milk for cooking only. 

These still form the broad, general basis for grading. 

In 1911 announcement was made that after Jan. 1, 1912, all 
milk except special high-grade milk was to be pasteurized. The 
warning of this contemplated action was given so far ahead 
because of the necessity of making changes in the plants of 
milk dealers. 



224 

At the end of 1911 there was a conference participated in by 
dealers, the New York Milk Committee, the officials of the 
Department and certain physicians, which assumed that in 
addition to pasteurized milk two grades of raw milk, one for 
children and one for adults, could be sold, based on prescribed 
tests for tuberculosis in cows. These rules went into effect in 
1912, and are indicated in table on page 228. This step was 
enabled by the advance of knowledge as to pasteurization, and, 
as will be seen, by recognition of the impossibility of properly 
inspecting a raw milk supply of this size. It was in no sense a 
backward step. In the year 1913, from the outbreak of a very 
bad milk-borne typhoid epidemic (1,100 cases in all), there 
resulted the abolition of Grade B raw milk, the pasteurization 
of all milk of this grade, and the establishment of bacteriologic 
standards throughout. There resulted likewise the simplifying 
of Grade A and the inclusion of cream in the pasteurization 
requirements. 

This summary gives some indication of the weary road trav- 
ersed by those men to whom is due the credit for the present 
excellent supply of milk for New York City. It will be noted 
that the essential features are pasteurization almost exclusively, 
and bacteriologic control of the raw and pasteurized milk, ex- 
cept in Grade A, It will be noted from table on page 229 that 
dairy scores are still used to assist in controlling the farms. 
This in no sense allows of the pasteurization of dirty milk. As 
a matter of fact, as is well known to those having to do with 
milk control, dirty dairies with their concomitant of careless 
and dirty methods almost invariably produce dirty work, while 
on the other hand the clean dairy produces clean milk. Be- 
cause of this human factor a fair control of the condition x)f 
Grade B dairies may be effected through the bacteriologic ex- 
amination of the milk. Grade A, which is naturally that milk 
requiring more supervision, is, of course, designed for the use 
of children, and must be, therefore, absolutely above suspicion. 
By requiring that no milk of a lower grade than "A" be han- 
dled in a Grade A plant, the necessary distinction as to that 
grade -is readily secured. Mr. Russel Sturgis, chief of the 
Milk Division, of the Bureau of Food and Drugs of the Health 
Department of New York City, in an excellent paper published 



225 

in 1915, on "The Role of Dairy Inspection in Safeguarding a 
City's Milk Supply," and to which I am indebted for a very 
large part of what I have been saying, suggests that possibly 
at some future time, when the private inspection systems of 
the milk companies have been more completely developed, it 
will be found that the score card standard, at present neglected, 
will be appreciated as a measure of value. As a matter of 
actual fact, all companies handling milk desire of course to 
furnish Grade A milk, selling for the highest price. They there- 
fore pay the farmer a premium for clean dairies and clean milk, 
and this operates as an incentive to the producer to improve 
his conditions. 

It has often been objected to pasteurization, in the language 
of certain gentlemen of florid imagination, that the sale of pas- 
teurized milk containing dead organisms — a sort of bacteria 
soup — is strictly parallel to the sale of a milk soup made from 
oysters of an uncertain vintage. I think experience hardly sus- 
tains this violent assumption. Whether it be true or not, how- 
ever, the impossibility of handling a very large milk supply, 
such as that for the city of New York, without prohibitive cost 
for inspection, as well as without raising the cost of raw milk to 
the consumer to a prohibitive figure, can be readily appreciated. 
Moreover, a raw milk supply of this size which is absolutely 
safe is a matter of practical impossibility under present con- 
ditions; if for no other reason, because of the absolute impos- 
sibility of keeping out, in the enormous number of people 
through whose hands the milk supply goes before reaching the 
consumer, carrier cases of typhoid, diphtheria and the like. 

In addition to the occasional farm inspection by the Depart- 
ment, farm inspection is promoted on the part of the companies 
by the necessary connection of conditions indicated by our in- 
spections and counts, by the efforts of small companies trying 
to remedy faults, and by dairymen who are trying for the pre- 
miums for high dairy scores given by the companies. It may 
be further added that prior to 1912, and the inception of this 
system of milk control, one or more typhoid outbreaks every 
year in New York City which could be directly fastened on 
the milk supply were the rule, and usually these were of very 
considerable size. 



226 

In 1914 and 1915 there has up to date been only one small 
milk-borne epidemic of typhoid, promptly stopped by shutting 
off the milk supply, and only 90 direct cases in all. This oc- 
curred in a pasteurized supply, and appears to have been due 
either to a carrier case handling the milk after pasteurization, 
or, much more probably, to the water supply of the creamery 
becoming suddenly polluted. 

A short description of the methods used by the Department 
may be of interest. It is required that the pasteurization be 
conducted between 142° F. and 145° F. for not less than thirty 
minutes; and, of course, cooling after pasteurization must be 
very prompt. In making his inspection the operator, of course, 
carefully examines all pipes and connections from pumps and 
other apparatus, taking everything apart if necessary to assure 
himself of cleanliness. He watches the sterilizing of the pipes 
and vats before use. In the actual handling of the milk he 
notes its condition as to dirt upon receipt, and watches to see 
that it is not exposed to dust. If the automatic temperature 
recorder is used its accuracy is tested at each inspection. These 
recording devices indicate the holding period very well except 
in case of continuous retarders, and in this type of apparatus 
the holding period is best ascertained by watching the speed 
at which the milk is dumped through. It is cooled, preferably 
to 45° or lower, and then the milk is immediately bottled or 
canned for shipment. By taking the temperature of cooling at 
frequent intervals the inspector is able to advise whether the 
hot milk is fed to the cooler too fast to obtain good results. 
Special stress is laid on the cleanliness of bottles and cans used 
for holding pasteurized milk. For this a sterile water control 
is used in the bacteriologic examination, and inspectors are 
kept closely informed of all results, their personal effort being 
of great value in this connection. Water samples for this pur- 
pose are transmitted to the laboratory for a count in the same 
way as the milk samples, 50 cubic centimeters of sterile water 
being used for washing each can or bottle. The accepted stand- 
ard is 1,000 total bacteria in each 50 cubic centimeters so 
treated for bottles and 10,000 for cans. 

Schedules for inspection are so arranged that samples of milk 
are taken during inspection of pasteurizing plants at certain 



227 

intervals. I quote from Sturgis's paper previously mentioned, 
as follows: — 

Four samples are taken at each of the various steps, and from those 
four individual samples an average is obtained which fairly reflects the 
quantity of the milk and also serves as a check upon the thoroughness of 
pasteurization. Usually these samples are taken from (a) the raw milk; 
(6) at the outlet of the holder, or after the milk has been heated and held; 
(c) from the outlet of the cooler; (d) from bottles or cans that have been 
filled for shipment. These samples are thoroughly chilled, packed in ice, 
and shipped in the milk car to the city terminal,- where they are collected 
upon arrival and taken to the laboratory. 

Our present inspection force consists of 20 country inspectors 
and 12 city inspectors. The country inspector's duty consists 
in the inspection of plants as just mentioned, and of dairies. 
Grade A dairies are inspected three times a year, and as much 
oftener as possible. Other dairies are inspected when the occa- 
sion allows. All inspections of dairies and creameries are re- 
corded on score cards of the New York City form, the dairy 
cards being made in duplicate and a copy left at the farm. 
The pasteurizing plants are not scored, but are recorded on a 
special card where only changes from the last inspection are 
noted. This is also in duplicate, but the copy is sent to the 
office, and from there sent to the company responsible instead 
of being left direct with the company. On occasion the epi- 
demiology of suspected milk-borne diseases is investigated by 
these country inspectors. 

The city inspectors watch the supply to the point of delivery, 
that is to say, either to the retail store or to the customer. 
The stores themselves are inspected by inspectors of the Food 
Division of the Bureau of Food and Drugs", avoiding in this 
way duplication of work. Of the 12 city milk inspectors at- 
tached to the Division of Milk Inspection 3 are on bacteria sam- 
ples, 5 on samples for chemical analysis, 2 on pasteurizing plants 
alone, and 2 on the large city dairies and on the pasteurizing plants 
in outlying portions. It is interesting to note here that within 
the city of New York itself there are over 100 dairies, with 
about 5,000 cows. Each of the bacteria squad takes 68 samples 
daily of raw milk going to pasteurizing plants, or of the pas- 
teurized milk as offered for sale, making, all told (including 40 



228 

samples each for the two men on the pasteurizing plants), 284 
samples of milk taken in the city for bacterial examination 
daily. A list of the various supplies is furnished to each man, 
and it is estimated that he will cover his field in three to four 
weeks. The chemical squad takes samples from wagons, about 
65 a week in all. It will thus be noted that from 1,600 to 
1,800 samples for bacteriologic and chemical analysis are taken 
per week for milk inspection purposes. 

It is proper to state that for a considerable portion of the 
information given in this paper I am indebted to a monograph 
bearing the name of Lederle & Raynor, published by the De- 
partment of Health, and to the paper by Russel Sturgis, chief 
of the Division of Milk Inspection, heretofore alluded to. 

It is perhaps unnecessary for me to state that my recent 
connection with the New York City Health Department has 
made it impossible for me to prepare this paper without much 
help from others. 

1912. 

Grade A. 

1. Certified or guaranteed. 

2. Inspected raw. 

Dairies: — 

Equipment, . . . 25 

Methods, . .. . . .50 

Bacteria : — ■ 

60,000 per cubic centimeter. 

3. Selected pasteurized. 

Dairies: — 

Equipment, ........... 20 

Methods, ..... ; 40 

Bacteria: — 

200,000 per cubic centimeter before pasteurizing . 

50,000 per cubic centimeter after pasteurizing. 

Grade B. 

1. Selected raw. 

Dairies : — 

Equipment, . 25 

Methods, . . . ,. 43 

Bacteria shall not be excessive. 

2. Pasteurized. 

No dairy standard. 
No bacteria standard. 



229 



Grade C. 
For cooking (at first allowed raw). 
Later required heated or pasteurized (no standards). 

1914. 

Grade A. 

1. Raw. 

Dairies : — 

Equipment, 25 

Methods, 50 

Bacteria : — 
60,000 per cubic centimeter. 

2. Pasteurized. 

Dairies: — 

Equipment, . 25 

Methods, 43 

Bacteria : — 

200,000 per cubic centimeter before pasteurizing. 

30,000 per cubic centimeter after pasteurizing. 

Grade B. 
Pasteurized. 
Dairies: 1 — 

Equipment, 20 

Methods, 35 

Bacteria: — 

1,500,000 per cubic centimeter before pasteurizing in city. 
300,000 per cubic centimeter before pasteurizing in country. 
100,000 per cubic centimeter after pasteurizing. 

Grade C. 
Pasteurized. 
w Dairies: — 

Total, ._ 40 

^Bacteria: — 

300,000 per cubic centimeter. 

1 At present not enforced. 



230 



E. REPORT ON INFORMATION GATHERED AT THE CON- 
VENTION OF THE INTERNATIONAL MILK INSPECTORS 
ASSOCIATION. 

The following information was obtained from the lectures and 
from talking with various local inspectors : — 

Cumberland, Md. — All the milk comes from near home, within 30 miles. 
About one-half the supply is pasteurized and is not from tuberculin-tested 
cows. The standard is 12.50 per cent, solids, 3.50 per cent. fat. The price 
is 9 cents retail and about 4 cents wholesale. 

Detroit, Mich. — Supply comes from within 100 miles, and all has to 
be pasteurized, but does not come from tuberculin-tested cows. The 
standard is 12.50 per cent, solids, 3 per cent. fat. 

Seattle, Wash. — The supply comes from within 90 miles, and has to be 
either pasteurized or from tuberculin-tested cows. The standard is 3.25 
per cent, fat and not over 200,000 bacteria. The wholesale price is 16 
cents per gallon, and the retail price is 9 cents per quart. The United 
States score card is used and is relied upon absolutely. All employees in 
pasteurization plants have to be examined to see that they are not disease 
carriers. 

Manchester, N. H. — Nearly all the milk comes from near home, though 
a little comes 200 miles. Some is pasteurized. It is not from tuberculin- 
tested cows. Retail price is 8 cents per quart, while the farmer received 
3 to 5 cents per quart. 

Washington, D. C. — In 1872 the Washington Board of Health re- 
quired a permit for milk to come to the District from the surrounding 
country, but in 1884 this was stopped.- In 1892 the Sanitary League was 
formed, and obtained a law compelling inspection before granting permits. 
This law was passed in 1895. This was the first system of licensing and 
controlling the milk supply, and is the one still used in Washington. Con- 
gress passes the milk law for the District of Columbia. The standard is 
12.50 per cent, solids and 3.50 per cent. fat. All cattle have to be tuber- 
culin tested. 

Norjolk, Va. — Supply all raised within 7 miles, and about 40 per cent, 
is pasteurized and has to be from tuberculin-tested cows. Retail price is 
10 cents. There is not much wholesale milk, but the price is about 20 
to 23 cents per gallon. The fat standard is 3 per cent., and the inspector 
would prosecute below this figure. Certified milk must not contain over 
10,000 bacteria. The inspector likes the United States score card. He 
does not believe in milking machines, as they spoil the cow. 

New York. — The State standard and methods are used by all local 
inspectors except in cases where the cities or towns make regulations more 
drastic than that of the State. All milk has to be from tuberculin-tested 
cows or be pasteurized. Standard is 11.25 per cent, solids and 3 per cent. 



231 

fat. Milk is graded A, B and C raw and A, B and C pasteurized. For A 
raw milk the farmer must score at least 75, and the milk contain not over 
30,000 bacteria. Herd must be examined each year. The score must be 
at least 25 for equipment and 43 for methods. 

Grade B : Bacteria not over 200,000. Score must be 23 for equipment 
and 37 for methods, and herd must be examined each year. 

Grade B, pasteurized: Score must be 20 for equipment and 35 for 
methods, bacteria not over 1,000,000, and the herd must be tested each 
year. 

Grade C is anything from dairies scoring 40 points, but local authorities 
may make special regulations. 

Grade A pasteurized must not contain over 200,000 bacteria before 
pasteurization. 

The farmer receives 3| to 4 cents for A pasteurized grade, but for B 
grade is paid on a fat basis, which is lower. Retail price of A pasteurized 
and raw is the same, but most people prefer raw milk. About one-third 
of the milk is pasteurized by heating to 145° and holding thirty minutes. 
Heating too high breaks the cream line and spoils the looks of the milk. 

Most of this information was obtained from the Auburn, N. Y., 
inspector. 

In case of an epidemic the health officer notifies the State Health De- 
partment by telephone or telegraph. The State Department notifies the 
local authorities to shut off the supply, and it is done at once. The score 
card used in New York is a State one, but is a good deal like the United 
States card. 

Mr. Purrington of New Hampshire says in New Hampshire 
the milk business is a side issue, and the farmer generally 
peddles his milk himself instead of selling to large dealers. He 
usually has a poor equipment and cannot afford to pasteurize. 
Mr. Purrington does not believe the State has any right to give 
definite orders, provided the milk is low in bacteria. The score 
should not be relied upon as much as bacterial count. Twenty 
per cent, of the cattle in New Hampshire have tuberculosis, 
and the tuberculin test is not general. The State is encourag- 
ing "inspected milk." This is milk inspected and licensed by 
the State, and the license can be revoked. Dealers producing 
"inspected milk" are allowed a special cap with the State Seal 
upon it, and receive 1 cent per quart above the regular price. 
About 20 producers raise "inspected milk." Prices of milk are 
7, 8 and 9 cents. 

Tests are now being made to determine the cost of producing 
"inspected milk." 



232 

Dr. Wiley says that where dairy interests control, the stand- 
ard is low. Illinois has a low fat standard, — 3 per cent. He 
claims that New York and Ohio have much tuberculosis, as 
farmers are in control of Legislature and do not have proper 
inspection. Virginia has an inspection law, but not enough 
money to pay for condemned cows. He believes the United 
States should help States who try to stamp out tuberculosis. 
He believes milk should be graded, and the higher grade should 
receive the best price. 

Dr. States of Detroit believes that all milk and its products 
should be pasteurized. He claims that heating to 160° for 
thirty minutes will kill the germs. 

Professor Stocking of Cornell says that only a small propor- 
tion of milk drinkers get diseases from milk, but believes all 
this is preventable. 

Mr. T. of Washington, D. C, a milk dealer who lost his license, 
does not believe pasteurization kills germs of tuberculosis. 

The general opinion of those with whom the representative 
talked and the speakers was that all milk should be pasteurized, 
though some believed that mMk from tuberculin-tested cows 
was safe if consumed raw. Dairy inspection and the use of the 
United States score card were recommended, although the score 
card should not be used as a standard for judging the milk, the 
bacterial count being more important. Mississippi and Wash- 
ington do not allow disease carriers or those recently having 
disease to handle milk, and Seattle requires Widal tests from 
all employees in dairies. Montclair requires a health certificate 
every three months for employees in plants where milk is not 
pasteurized. 

Mr. Stephenson of Washington, D. C, believes in milking 
machines where labor is scarce, but thinks it takes experienced 
men to use them. They do not pay for less than 20 cows. No 
special mention was made regarding different kinds of machines. 
One or two men believed in the use of clarifiers, though the use 
of them usually increased the number of bacteria. 

No one knew of any portable forms of pasteurizers or cheap 
forms for small dealers. Co-operative or city plants were sug- 
gested, or the use of a wash boiler, as a cheap form of pas- 
teurizer, in the home in case of epidemics. 



233 

The need of pasteurization or tuberculin-tested cattle and 
the medical inspection of employees in dairy plants were gen- 
erally agreed upon, though the additional cost of the milk and 
the driving of small dealers from business were reasons ad- 
vanced against these ideas. The United States score card 
seems to be considered the best standard there is for dairy 
inspection, and no changes were suggested. 



F. DIGEST OF RECENT AMERICAN MILK LEGISLATION BY 
VARIOUS CITIES AND STATES. 

The following milk . laws and regulations were taken from 
the bulletins of the United States Public Health Service. They 
tend to show the attitude of health authorities toward (1) 
securing milk from cattle free from tuberculosis, (2) protection 
of milk against contamination from human sources, and (3) 
rendering uncertified milk safe for human consumption. The 
essentials of the various State laws applying to the protection 
of milk against contamination from human sources are as 
follows : — 

California. — Requires by law that whenever a case of communicable 
disease occurs in the house of a milkman, milk distributor or dealer 
no milk is to be sold or distributed by him until the health authority 
designates a person to conduct the business and to see that no com- 
munication is maintained with the infected house except under official 
supervision. 

New Jersey. — State Board of Health or its officers required to prohibit 
transportation of milk believed to have been contaminated from infected 
persons. 

Colorado, Connecticut, Illinois, Maine, Maryland, Massachusetts, Mich- 
igan, Nebraska, New Jersey, New York, North Dakota. — Prohibit sale of 
impure milk or milk products produced under unsanitary conditions. 

Idaho, Utah and Wyoming. — Forbid by regulation the sale of milk 
from quarantined premises. 

Pennsylvania. — State Board of Health requires local health official to 
notify county medical inspector when milk is marketed from premises in 
which communicable disease prevails. 

Colorado, Connecticut, Illinois, Maine, Massachusetts, Michigan, Ne- 
braska, New Jersey, New York, North Dakota. — Persons in charge of dairy 
farms or dairies are required to report communicable diseases on their 
farms to health authorities. 

Ohio. — Requires milk from infected places to be stopped. 



234 

California. — Requires pasteurization by law (act of May 4, 1915). 
No person, firm or corporation shall sell, exchange or offer or expose or 
have in its possession for sale or exchange any milk, cream, skim milk, 
ice cream, butter, buttermilk, cheese or other milk product as the case 
may be nor use the word pasteurize or any of its derivatives in connection 
with the sale, etc., unless the same and all products of milk have been 
treated by the process of pasteurization. 

Durham County, N. C, has a regulation with special refer- 
ence to communicable diseases in persons engaged in the pro- 
duction or handling of milk, which reads as follows : — 

No person having tuberculosis, any venereal disease, or any other com- 
municable disease shall work in any milk depot, dairy, or in any other 
place where milk or its products are handled. When typhoid fever, scarlet 
fever, diphtheria, small pox, measles, or chicken pox occur in a house or 
family of any one engaged in the handling of milk it shall be the duty of 
the owner or manager to notify the superintendent of health at once of 
this fact. Examination is required when communicable diseases are sus- 
pected. Any dairyman or milk dealer authorized under this ordinance 
or any employee engaged in any way in producing and handling milk or 
any member of their families, or any persons, residing in the house or on 
the premises occupied by such person, if suspected of having any com- 
municable disease, may be required to submit to an examination at the 
hands of the superintendent of health. . . . Failure to co-operate with 
the superintendent in carrying out the provisions of this section shall be 
punished by the revocation of the permit held by such person, firm, or 
corporation. 

For the securing of milk from cattle free from tuberculosis 
Richmond, Va., and Durham County, N. C, have the follow- 
ing regulations : — 

Richmond, Va. — Beginning on and after September 1, 1915, no person, 
firm or corporation shall sell or offer for sale or otherwise dispose of within 
the city of Richmond or shall transport or carry for the purpose of sale in 
said city, or shall have in his or their possession with intent to sell or offer 
for sale or otherwise dispose of in said city, any milk or cream produced 
in whole or in part from cows which have not been demonstrated by the 
tuberculin test to be free from tuberculosis, said test to have been made 
within one year. Penalty for violation, . . . said milk or cream shall be 
condemned and destroyed by the food inspector or one of his assistants. 

Durham County, N. C. — It shall be unlawful for any person, firm or 
corporation authorized under the provisions of this ordinance to operate 
or maintain a dairy for the production of milk, cream, or buttermilk for 



235 

sale or other distribution in the city of Durham or sanitary districts of 
east or west Durham, to use the milk of or from any cow that has not been 
tuberculin tested by the meat and milk inspector or other officers assigned 
to make such tests. 

Spokane, Wash., has a regulation with regard to pasteuriza- 
tion which makes it unlawful for any person to deliver, sell or 
have or offer for sale or delivery in the city of Spokane, any 
pasteurized milk unless the same shall have plainly marked on 
each bottle a label bearing the inscription "Pasteurized Milk," 
and unless the same shall have been pasteurized within twenty- 
four hours prior to delivery to the consumer, etc. 

The following are sections taken from the 1915 ordinance of 
Seattle, Wash. They are models that might well be followed 
by other communities. 

Section 16. Provides that the Commissioner of Health shall have the 
right and is hereby empowered to condemn, render unsalable and return 
to possessor at his expense, milk to which any foreign substance has been 
added, etc. 

Section 19. Provides that the Commissioner of Health shall have 
power to revoke all permits to receive milk within the city of Seattle from 
dairies, etc., outside of the city . . . whenever he shall deem such action 
necessary. 

Section 31. Provides that it shall be the duty of the Commissioner 
of Health as often as he shall deem necessary to inspect all dairies . . . 
located outside the limits of the city of Seattle, from which milk is shipped 
or brought into the city of Seattle. 

Section 34. Provides that the Commissioner of Health shall have the 
right and is hereby empowered to, and it is hereby made his duty to ad- 
minister to all cows within the city of Seattle, an accepted test for the 
detection of tuberculosis, as often as he shall deem necessary. ... All 
animals reacting to the tuberculin test shall be marked in a manner satis- 
factory to the Commissioner of Health for purpose of identification. . . . 
He is empowered to revoke permit issued to any person to sell milk within 
the limits of the city when any cow reacts to accepted test . . . and is 
not immediately disposed of satisfactory to the Commissioner of Health. 
Aforesaid test not required . . . when all the milk produced ... is pas- 
teurized ... as defined in another section. 

Section 37. Provides that it shall be the duty of all persons having 
charge or control of all dairies, etc., ... to notify the Commissioner of 
Health of any suspected or positive case of typhoid fever, small pox, diph- 
theria, scarlet fever, tuberculosis, septic sore throat or any other com- 
municable disease in any person upon such premises and no person suf- 



236 

fering from, or those coming in contact with such persons, etc., shall work 
in or about the premises where milk is produced, handled or offered for 
sale, for consumption. 

Section 38. Provides that all persons handling milk to be sold in the 
city of Seattle, shall be subject to medical examination by the Commis- 
sioner of Health, free of charge. ... In case of refusal to permit said 
examination . . . permits to sell milk in the city of Seattle shall be per- 
manently revoked. 

Section 44. Provides a penalty not exceeding one hundred (100) dol- 
lars, or imprisonment in the city jail not exceeding thirty (30) days, or 
both for violation of any of the provisions of the ordinance. 



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249 



Appendix B. 

FORMS OF QUESTIONNAIRE AND LE ™^ENT TO LOCAL 
BOARDS OF HEALTH, AND A LIST 01 Oil ISA Amu 
TOWNS FAILING TO REPLY TO QUESTIONNAIRE. 

Massachusetts State Depaktment op Health, 
Boston, July 21, 1915. 

To the Local Board of Health. 

■ Gentlemen: -The State Department of Health is making a study 

of the relation of milk to the transmission of disease. 

We are desirous of getting as complete a record as pos.be of all ca 
of typhoid fever, diphtheria, scarlet fever and septic sore throat, where 
nlilk has been proven to be or has been suspected of bemg the means of 

'Tetm appreciate it, therefore, if you will fill out the enclosed blank 
and forward it to us at your earliest convenience together with any 
other facts which you feel may have a bearing on this important matter. 
Bv direction of the Commissioner of Health, 

Sincerely yours, 

Eugene R. Kelley, 
Director of Division of Communicable Diseases. 



_1915. 



Dr Allan J. McLaughlin, Commissioner of Health, State Department 

of Health, State House, Boston, Mass. 

Dear Sik: - Below you will find a list of the cases of the following 

. ... during the 

""« by' this Department with ' reference to mitt 

Supply. Total Number of Cases due to Cases, Milk 

Diseases. Cases, 1909-13. Milk. suspected. 

Typhoid fever, 

Diphtheria, 

Scarlet fever, 

Septic sore throat, v rf ^^ due ^ Death Milk 

Diseases. Deaths, 1909-13. Milk. suspected. 

Typhoid fever, 
Diphtheria, 
Scarlet fever, 
Septic sore throat, 



Yours very truly, 
Agent or Secretary of Board of Health. 



250 



Massachusetts State Department op Health, 
Boston, Sept. 22, 1915. 
To the Local Board of Health. 

Gentlemen : — Some time ago this Department sent to all local boards 
of health in the Commonwealth a questionnaire on the relation of milk 
to certain diseases. In looking over our returns we do not find your 
reply among them. This is probably an oversight. 

We need this information to complete our report on the milk question 
for the next General Court. The value of these replies will be directly 
proportional to number of towns reporting. The subject of milk in its 
relation to disease is so important to every city and town that it ought 
to amply repay any local board of health for their trouble in looking 
up their records on the subject. 

As you know, the reports of infectious diseases, as they are forwarded 
to this office, do not indicate the known or suspected source of the in-* 
fection. Consequently, this Department can only gather such informa- 
tion as is asked for in this questionnaire through the co-operation of the 
local boards of health. We would, therefore, very greatly appreciate 
an early return of the enclosed questionnaire, even if your records do 
not show any cases or deaths due to diseases transmitted by milk. 

By direction of the Commissioner of Health, 

Sincerely yours, 

Eugene R. Kelley, 
Director of Division of Communicable Diseases. 



Cities and 
Abington. 
Acton. 
Adams. 
Agawam. 
Amherst. 
Arlington. 
Ashfield. 
Barre. 
Bedford. 
Belchertown. 
Bellingham. 
Berkley. 
Berlin. 
Bernardston. 
Billerica. 
Blandford. 
Bolton. 
Boxborough. 
Boylston. 
Brewster. 



Towns that have not replied to 
Bridgewater. 
Brimfield. 
Buckland. 
Burlington. 
Charlemont. 
Chelmsford. 
Chilmark. 
Clarksburg. 
Concord. 
Conway. 
Dalton. 
Dana. 
Dedham. 
Dighton. 
Dudley. 

East Bridgewater. 
East Longmeadow. 
Egremont. 
Enfield. 
Essex. 



Milk Questionnaire. 
Falmouth. 
Florida. 
Foxborough. 
Gardner. 
Gay Head. 
Georgetown. 
Gill. 
Goshen. 
Grafton. 
Granby. 
Granville. 
Groveland. 
Hadley. 
Halifax. 
Hamilton. 
Hancock. 
Hardwick. 
Harvard. 
Harwich. 
Hawley. 



251 



Cities and Towns 

Heath. 
Hingham. 
Holbrook. 
Holliston. 
Hopkinton. 
Hudson. 
Hull. 

Huntington. 
Ipswich. 
Kingston. 
Lakeville. 
Lee. 

Leicester. 
\ Lenox. 
Leverett. 
Leyden. 
Lincoln. 
Littleton. 
Longmeadow. 
Ludlow. 
Lynnfield. 
Manchester. 
Mansfield. 
Marblehead. 
Marlborough. 
Marshfield. 
Mattapoisett. 
Maynard. 
Medfield. 
Medway. 
Middleborough. 
Middlefield. 
Middleton, 



that have not replied to Milk 
Milford. 
Milton. 
Monson. 
Monterey. 
Nahant. 
Nantucket. 
Natick. 
Norfolk. 

North Attleborough, 
Norton. 
Norwood. 
Oak Bluffs. 
Orange. 
Otis. 

Pembroke. 
Peru. 

Plymouth. 
Plympton. 
Eandolph. 
Rehoboth. 
Richmond. 
Rockland. 
Rowley. 
Royalston. 
Rutland. 
Salisbury. 
Savoy. 
Seekonk. 
Sheffield. 
Shelburne. 
Shrewsbury. 
Southampton. 
Southwick. * 



Questionnaire — Concluded. 
Spencer. 
Sterling. 
Stoneham. 
Stoughton. 
Sturbridge. 
Sudbury. 
Sutton. 
Templeton. 
Tewksbury. 
Tisbury. 
Uxbridge. 
Wales. 
Wareham. 
Warren. 
Washington. 
Way land. 
WeMeet. 
Wendell. 

West Bridgewater. 
West Brookfield. 
West Springfield. 
West Stockbridge. 
Westborough. 
Westford. 
• Weston. 
Weymouth. 
Whately. 
Whitman. 
Wilbraham. 
Williamsburg. 
Wrentham. 



252 



Appendix C 



ABSTRACT OF MILK-BORNE EPIDEMICS IN MASSACHU- 
SETTS FROM 1906-15. 

The following is an abstract of epidemics investigated by the 
State Board and Department of Health of Massachusetts from 
1907 to 1915, in which milk was either definitely proven to have 
been a means of transmission of the infection, or in which the 
epidemiological evidence of milk as the cause was considered 
strong enough to classify the outbreak as among the milk-borne 
outbreaks. 



253 



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Number of 
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Diphtheria, 
Scarlet fever, 
Septic sore throat, 
Typhoid fever, . 



262 



Appendix 



COPY OF LETTER SENT TO, AND REPLIES FROM, EPIDEMI- 
OLOGICAL AUTHORITIES OF OTHER STATES RELATIVE 
TO MILK AND DISEASE. 

The following is a copy of the letter sent to, and replies re- 
ceived from, the epidemiological authorities of New York, New 
Jersey, Pennsylvania, Maryland, Minnesota and Kansas: — 

Boston, Mass., July 30, 1915. 

Dear Doctor: — This Department is making a study of the relation 
of milk to communicable diseases. 

We are especially anxious to get all the data possible on cases of ty- 
phoid fever, diphtheria, scarlet fever and septic sore throat where milk 
has been implicated in the transmission of the infection. Are your routine 
epidemiological reports such that we might get from them an idea of the 
relative frequency of milk as a means of transmission of these diseases in 
your State? Would it be asking too much to let us have any reports, analy- 
ses or studies along this line that have been made by your department? 

While we appreciate the extent of this request, we are impelled to 
make it only by our willingness to co-operate with you in a like manner 
at any time. 

By direction of the Commissioner of Health, 

Sincerely yours, 

Eugene R. Kelley, 
Director of Division of Communicable Diseases. 

Board or Health of the State of New Jersey, Trenton, Aug. 2, 1915. 

Eugene R. Kelley, M.D., Director of Division of Communicable 
Diseases, State Department of' Health, Boston, Mass. 
Dear Doctor: — I am in receipt of your communication of July 30 in 
which you ask for information in regard to cases of typhoid fever, diph- 
theria, scarlet fever and septic sore throat traceable to milk infection. 

We have no special articles on this subject, but I believe there is on 
file in your office a complete set of the annual reports of tho State Board 
of Health, and in the reports of the last five or six years you will find 
reports of interesting epidemics of this nature which have occurred in 
the State of New Jersey. 
With kindest regards, I am 

Very truly yours, 

A. Clark Hunt, M.D., 

Chief. 



263 



Department of Health, City op New York, 
Bureau op Preventable Diseases, 
139 Centre Street, New York, Dec. 31, 1915. 

Dr. Eugene R. Kelley, Director, Division of Communicable Diseases, 
Massachusetts State Department of Health, Boston, Mass. 

Dear Doctor: — You, of course, understand the impossibility of 
judging the number of deaths in endemic typhoid due to milk, for the 
reason that no one can designate the cases as they appear. All that 
we can do in this respect is to weigh one set of milk conditions against 
another and ascribe the difference to one of them. This is what we have 
done in comparing the number of cases prior to pasteurization of milk 
with the number after the pasteurization of milk. As the fall was an 
abrupt one we felt that we were right in our conception as to the relative 
responsibility of raw milk for the endemic disease, especially as the figures 
corresponded so closely with those forecast after considering the ex- 
perience among the patrons of a milk company selling from one to two 
hundred thousand quarts a day of pasteurized milk as compared with 
all of the other milk, most of which was unpasteurized. I must admit 
I have nothing more than just this, and at the same time I can account 
for the change in no other way. 

While we cannot give you the actual number of cases and deaths in 
the so-called residual milk-borne typhoid, we have them for outbreaks 
and submit the following : — 

1912 184 cases 22 deaths. 

1913, 561 cases 61 deaths. 

1914, . . . . . No outbreaks. 

1915, . . . . .119 cases, . . . . .15 deaths. 

This brings to your attention an outbreak in 1915, after pasteuriza- 
tion was generally established. This was a very interesting occurrence. 
On July 19, 1915, 3 cases of typhoid fever were reported from one com- 
paratively small company, one doing a business of about 10,000 quarts 
in a limited area, supplying about one-tenth of the population therein. 
The company had several creameries, but all 3 cases were supplied by 
one creamery. On the succeeding day 3 other cases were reported. Tele- 
phone inquiry developed the fact that various creameries had contributed 
to their supply, but this particular creamery had participated in each 
instance. The milk was thereupon excluded from the city. 

A careful survey of the conditions at the creamery town showed 
several cases of typhoid fever in the community, and an examination of 
the well water used in washing the bottles and machinery showed a 
high degree of contamination. For the bottles only hot water or steam 
was used, but on the machinery, especially on the bottler itself, cold 
water had been used followed by hot steam for sterilization. Under 
the conditions, 'the steam penetrated to most parts of the machine, but 
did not get access to the drop or funnel arrangement by which the milk 
was directly conveyed to the bottles. As a certain amount of milky 



264 

water remained in this situation over night it was surmised that typhoid 
bacilli may have been present and developed through culture over night, 
resulting in a high degree of contamination of the freshly pasteurized 
milk. The well was, of course, at once sealed up before the milk was 
allowed to re-enter, and there has been no further trouble. No typhoid 
bacilli, however, were found in the water, though colon bacilli were present 
in yioo cubic centimeter, as obtained directly at the well. This goes 
to show the danger subsequent to pasteurization under the present 
methods. 

Of course, pasteurization in bottles would obviate all of this, but the 
expense of the glassware and the manipulation would be enormous. 

Very truly yours, 

M. L. Ogan, 
Chief, Division of Epidemiology. 

New York State Department of Health, Albany, Dec. 9, 1915. 

Dr. Eugene R. Kelley, Director, Division of Communicable Diseases, 
State Department of Health, Boston, Mass. 

Dear Dr. Kelley: — Your letter of November 27, relative to the 
number of cases of communicable disease that were transmitted by 
infected milk in this State, is received. I have delayed, replying because 
I hoped to be able to tabulate the reports of the sanitary supervisors 
on this subject, but I find that many of them reported the outbreaks 
with a question mark as to whether or not milk was a means of trans- 
mitting the disease. I have, therefore, addressed a special memorandum 
to them asking them to review their work during the past year, and give 
me a statement of the number of outbreaks which they have had due 
to infected milk, stating the number of cases and deaths connected with 
each outbreak. I think that this report will be much more accurate 
than one which I could tabulate from the records. 

As soon as this report is received I shall be glad to forward a copy to 

you. 

Very truly yours, 

F. M. Meader, 
Director, Division of Communicable Diseases. 

State of Maryland, Department of Health, 

16 West Saratoga Street, Baltimore, Sept. 30, 1915. 

Dr. Eugene R. Kelley, Director, Division of Communicable Diseases, 
State Department of Health, Boston, Mass. 
Dear Doctor: — Several weeks ago you requested data on milk- 
borne outbreaks of typhoid fever, diphtheria, scarlet fever and septic 
sore throat in Maryland. A prolonged absence from the city, combined 
with an unusual press of official work, prevented my sending you this 
information at an earlier time. If you already have read your paper 



265 

on the subject, I trust this material may still be of service to you in your 
printed article. 

We have had no epidemic of diphtheria or of scarlet fever in which 
the milk supply was implicated, but we have had 7 outbreaks of typhoid 
fever and 1 of septic sore throat attributed to milk. I shall next give 
a summary of the typhoid outbreaks, arranged in chronological order. 

Milk Outbreaks, Typhoid Fever, in Maryland. 

1. The first recorded milk epidemic of typhoid fever in Maryland 
occurred in Elkton, Cecil County, in July, August and September, 1884. 
There were 20 cases, but no death. All of the cases but one were supplied 
with milk from a certain dairy where there was an undoubted case of 
typhoid fever. The outbreak ended when the use of this dairyman's 
milk was discontinued. 

2. Late in the summer and early in the autumn of 1900 another milk 
epidemic of typhoid fever occurred in Elkton, Cecil County. This out- 
break, 1 traceable to a single dairy, comprised 64 cases, two of which — a 
white woman aged fifty-six, and a young colored woman — proved 
fatal. The outbreak began on October 11 and subsided after October 29. 
Within the first eighteen days, during which time the dairyman's business 
continued, 39 cases of typhoid fever occurred. He ceased selling milk 
on October 28. Within three weeks following that date 20 additional 
cases occurred. Altogether there were 39 infected houses. The dairy- 
man claimed to be regularly supplying 80 houses. On this basis the 
house incidence was 48.75 per cent. In the 39 infected houses there 
were 180 people, an attack rate of 33| per cent. The case rate was 1.54 
per house. The light fatality, 3.3 per cent., suggests a contagium of 
slight virulence. The incubation period was variable, ranging from nine 
to eighteen days. The first 21 cases seemed to indicate periods of in- 
cubation averaging under rather than over fourteen days. Three of the 
patients had suffered previous attacks, one in 1884, one in 1893 and 
one in 1898. 

3. In 1903 an outbreak consisting of 26 cases of typhoid fever, 4 of 
which terminated fatally, developed among the employees of a shirt 
factory located in Baltimore City. The firm operating the factory served 
dairy lunch, the milk of which came from a farm where the water supply 
was polluted. The epidemic ceased when the milk supply was changed. 

4. In May, 1904, there was a milk outbreak of typhoid fever, con- 
sisting of 17 cases with 1 death, at Port Deposit, Cecil County. The 
incubation period, as is usual in milk-borne typhoid fever, was short, 
all of the cases having been taken ill within a period of ten days. They 
had a common milk supply, and were, users of raw milk. Previous to 
the outbreak there had been a case of illness on the dairy farm which 
was diagnosed "grippe." 

i See an interesting and comprehensive report of this outbreak by Dr. Fulton, in the Journal 
oflHygiene, London, Vol. I., 1901, pp. 422-429. 



266 

5. In October, 1905, there was another milk outbreak of typhoid 
fever in Port Deposit. This outbreak, explosive in character and limited 
to the users of one milk supply, comprised 19 cases, 1 of which proved 
fatal. A case of typhoid was found on the farm supplying the milk. 
The outbreak ceased when the sale of this milk was stopped. 

6. In April, May and June, 1906, there was a remarkable rise in the 
number of cases of typhoid fever in the Woodberry-Hampden district 
of Baltimore City. This outbreak, which occurred on one milk route, 
led to the discovery that one of the farms supplying this milk had cases 
of the disease among the employees, one of them being a milker. Stopping 
the sale of this milk put an end to the epidemic, which totaled 157 cases. 

7. In May and June of the present year (1915) there was an outbreak 
of typhoid fever at the Maryland Tuberculosis Sanatorium, which at- 
tacked the several groups of patients and employees using milk from 
"one of the 7 dairymen supplying the institution. Upon investigation 
it was found that an unrecognized case of typhoid fever had occurred 
in April, in the wife of the dairyman furnishing the infected milk. The 
outbreak subsided when the sale of milk from this dairy was stopped. 
The outbreak consisted of 27 cases, 19 of them tuberculous patients 
and 8 healthy persons. Three deaths occurred in the former group, 
and none in the latter. 

Septic Sore Throat. 
So far we have had but one explosive outbreak of septic sore throat 
in Maryland, spread through the agency of milk. This occurred in 
Baltimore City and its immediate vicinity, in February and March, 
1912. The extent of this epidemic, apparently a streptococcus infection, 
can only be surmised. It may be estimated that certainly not less than 
1,000 and perhaps as many as 3,000 cases occurred, causing 30 or more 
deaths. Over 85 per cent, of the cases were in families obtaining their 
milk supply wholly or in part from a single dairy. 

Very truly yours, 

C. W. G. Rohrer, 
Acting Chief, Bureau of Communicable Diseases. 

P.S. — Under another cover I am sending you three reprints on the 
septic sore throat epidemic, described in the paragraph immediately 
preceding. Two are by Dr. Hamburger and the third by Dr. Frost. 

I presume you already possess a copy of Hygienic Laboratory Bulletin 
No. 41, entitled "Milk and its Relation to the Public Health," published 
in 1908. It is replete with information bearing upon the relation of 
milk to the spread of communicable diseases, etc. — C. W. G. R. 



267 

[Extract.] 

Nov. 27, 1915. 

Dr. C. Hampson Jones, Chief of Bureau of Communicable Diseases, De- 
partment of Health, Baltimore, Md. 
Dear Dr. Jones: — 

We were much interested in receiving a communication from Dr. 
Rohrer, giving the frequency of milk-borne epidemics of typhoid fever, 
scarlet fever and diphtheria according to his records. The question has 
come up as to whether or not these figures include Baltimore. Will you 
kindly let me know? 

Sincerely yours, 

Eugene R. Kelley, 
Director of Division of Communicable Diseases. 

State op Maryland, Department of Health, 

15 West Saratoga Street, Baltimore, Nov. 29, 1915. 

Dr. Eugene R. Kelley, Director, Division of Communicable Diseases, 
State Department of Health, Boston, Mass. 

Dear Doctor: — In looking over Dr. -Rohrer's letter to you I find 
that his report includes those outbreaks of disease that occurred not 
only in the State, but in Baltimore City. 

I found, however, that one similar outbreak in Baltimore City has 
been omitted which occurred while I was there, and a report of it was 
made at the time of its occurrence, but I regret to say that I cannot now 
give a reference to the same nor the exact date of outbreak. It is my 
impression that it was somewhere between 1908 and 1910, and that it 
occurred in summer time, and the cases were detected by the system 
we had in the Health Department of daily scanning the report cards of 
the health wardens by an officer of the Food and Dairy Division, the 
health warden's cards showing what milk was consumed by the family 
of the sick one. 

A dairy located in the tenth ward suddenly looming up with a number 
of cases caused a review to be made of the producing dairies which were 
sending milk to it, which in this case fortunately happened to be but 
few, — not more than four, — so we quickly examined the condition of 
the farms of each producing dairy and found a typhoid fever case in a 
Harford County dairy that was sending the milk to the distributing 
dairy in Baltimore City. The closing of the producing dairy until all 
danger had passed effectually and quickly stopped the distribution of 
the disease. My recollection is that there developed between 55 and 
60 cases of typhoid fever on this man's milk route. 

Yours respectfully, 

C. Hampson Jones, 
Chief, Bureau of Communicable Diseases. 



268 



Minnesota State Board of Health, 

Division of Preventable Diseases, 
University Campus, Minneapolis, Minn., Aug. 3, 1915. 

Dr. Eugene R. Kelley, Director, Division of Communicable Diseases, 
Massachusetts State Board of Health, Boston, Mass. 
Dear Dr. Kelley: — We will be glad to co-operate with you in 
every possible way in your study of the relation of milk to typhoid, 
diphtheria, scarlet fever and septic sore throat. 

We have had no outbreak of septic sore throat reported in Minnesota. 
We have a considerable number of records showing the influence of milk 
in the spread of other diseases. I will collect this information for you 
as soon as time permits and forward it. , 
With kindest regards, I am, 

Respectfully, 

A. J. Chesley, 

Director. 

Minnesota State Board of Health, 

Division of Preventable Diseases, 

Minneapolis, Minn., Aug. 23, 1915. 

Dr. Eugene R. Kelley, Director, Division of Communicable Diseases, 
State Board of Health, State House, Boston, Mass. 

Dear Dr. Kelley: — In endeavoring to comply with your request, 
regarding instances in which milk has been implicated in the transmission 
of scarlet fever, diphtheria and typhoid fever, I am somewhat disap- 
pointed. 

Dr. Greene was kind enough to go through the records of the Division 
very carefully from Aug. 1, 1909, to date. He made a card index of 
reports where it seemed that milk might have been a factor in the spread 
of infection. 

I have gone through all these reports. While many of them indicate 
that milk was a factor to some extent in the spread of disease, only in a 
few was milk the chief route' of infection or definitely proven to be an 
active factor. As you know, many times we have been called only when 
the epidemic was at its height, sometimes even on the wane, and the 
data which are collected under such conditions are not conclusive, al- 
though they are very suggestive. 

Certain of the instances are given in the enclosed summaries. Others 
are to be found in the published reports. 

To begin with, I may mention one due to butter, not milk. The sum- 
maries for this will be found under the heading, Anoka Typhoid, May 
29 to 30 and June 5 to 6, 1912, page 240, Report of the Division of Epi- 
demiology, August, 1910, to August, 1912. 

Some explanation is necessary in addition to the information given 
in the Summaries. Dr. Hill made a very careful epidemiological study, 



269 

but was obliged to leave Anoka before he had finished, and sent me to 
finish the work. He left his epidemiological notes (mostly illegible), 
and told me how he had sized up the situation. Acting upon his theory 
of causation, I used such data as I could unravel from his notes, then 
attempted to solve the problem upon a certain hypothesis. I never did 
such a thing before, and have never attempted it since. Of course the 
hypothetical solution w^s to be checked up by actual investigation. 

Assuming that butter was responsible for the spread of typhoid in- 
fection, Dr. Hill had record of the number of persons in each family who 
used the suspected butter. A grocer simply acted as a distributor to 
regular customers. The packages were never opened between the dairy 
and the customer. There was record of every package delivered. Dr. 
Hill had noted whether the families had butter left from previous de- 
liveries or not. 

I weighed a piece of butter about the size of a chunk ordinarily con- 
sumed by one individual at a meal, and figured how many pieces of this 
size there would be in each jar delivered. On figuring out the time the 
butter would last, it appeared that it had all been consumed four days 
before Dr. Hill was notified that the epidemic was in progress, and there- 
fore all the precautions taken were of no avail. It appeared that other 
cases would come down, up to a certain time. 

For instance, in packing the butter into the jars, the upper part of 
the first crock would be contiguous to the bottom of the second jar; and 
if we assume that infection from the fingers occurred at this time, then 
the family using butter from the first jar should fall ill earlier than the 
family using butter from the second jar, because they would not get 
any infected material until the bottom of the jar was reached. In other 
families who had some butter from previous deliveries on hand, the 
infection would not be incurred at the time it would in the first family 
mentioned. 

The only persons who had typhoid who were not in the families of 
regular customers for this butter attended a church social where a woman 
who supplied butter had the jar from the dairy delivered at the time it 
was assumed the batch had been infected. It was one of those socials 
where certain items are supplied by certain women, and this lady supplied 
the infected butter, it seems. 

I went directly to the farm and found, upon questioning the people, 
that a girl visiting in the family had packed the particular batch of 
butter under suspicion. The farmer's wife made the butter, as usual, 
but on the morning it should have been delivered she was sick and asked 
the girl to pack the butter into the jars. This girl had been feeling unwell 
for some time, and had consulted a woman physician, who afterwards 
admitted that the girl undoubtedly had walking typhoid, although she 
did not report the case to the local health officer or send blood for Widal 
test. The symptoms the girl gave were suspicious. A blood test showed 
Widal reaction present. Attempts were made to isolate typhoid bacilli 



270 

from her discharges, and finally an organism was obtained which was 
typical for typhoid, except in one of the sugar media. It agglutinated 
with her blood. 

We did not tell the grocer or the customers that we had found the 
epidemic to be due to the use of infected butter. The farmer's wife had 
already made two or three batches of butter, and it had been used, and 
we let them go on just as usual. The butter found to be infected was 
the only batch which had been packed by any one except the farmer's 
wife. 

There is another instance given where cheese, as well as milk, had 
something to. do with the spread of typhoid infection. (See Summaries 
271 and 279, XIV.; also the extract from the health officer's report 
written on the back of the Confidential Data for 279.) 

We had a lot of trouble about this case, for the people sold their farm 
and moved into town, and later threatened to sue the health officer and 
the State Board of Health for ruining their business. 

In Summaries 60 and 73, XIII. , there is another instance of typhoid 
being spread by milk. 

Summary 132, XIII., is given to supplement the report on page 73 
of the Division of Epidemiology report, Aug. 1, 1912, to Dec. 31, 1913. 
While we did not personally collect the epidemiological data for the 
St. Paul cases, we checked over every point with the St. Paul Health 
Department, and I am sure that this showed a clear-cut milk-borne 
infection, although we did not prove by laboratory tests that the sus- 
pected carrier had typhoid bacilli in his discharges. 

In Summary 169, XIV., the solution is given for cases of typhoid in 
Stillwater which had not been traced previously. I made an investiga- 
tion there in 1912, and was unable to find the source of infection. It is 
true that there were but few cases, and they were scattered over a con- 
siderable period of time, making it impossible to get reliable information 
as to milk, etc., common to the different cases. Dr. Greene worked it 
out in 1914, and later Dr. F. L. Landeen gave us further information, 
as follows: — 

"I have a list of 16 typhoid cases, half of which I attended profession- 
ally. Twice, at least, cases have come in waves, those occurring eight 
years ago and this year (1914). Some cases were light, some ordinary 
and some fatal. I have no way of getting records further back than 
seventeen years ago, when the first case in my list occurred." 

Dr. Landeen stated that all of these cases were traceable to the carrier 
discovered by Dr. Greene. This woman had supplied milk to neighbors 
for many years. 

The final milk-borne typhoid report is that for the School for Feeble 
Minded at Faribault. You will find that Summaries 88 and 95, XIV., 
will give you a better idea of the conditions at the school than if you 
had only the three which relate specifically to the milk-borne infection, 
namely, 187, 197 and 232, XIV. There was further comment in the 



271 



State of Kansas, 
Department of the State Board of Health, 

Topeea, Kan., Aug. 6, 1915. 

Dr. E. R. Kelley, Director, Division of Communicable Diseases, Boston, 

Mass. 

Deak Doctor: — Replying to yours of July 29, will say that it has 
been impossible for this department to publish in a routine way all the 
epidemiological investigations. As you know, our bulletin is always 
crowded, and the State printer does not see fit to loosen up with any 
more paper. 

However, replying to your inquiry directly, will say that we have 
had only two epidemics traceable directly to milk in the past two years. 
One was the epidemic of typhoid at ' Parsons and another at Wichita. 
The Wichita report has not been published, but we are sending you here- 
with the Parsons report. The department has knowledge of other epi- 
demics which have been attributed to milk, but there are no definite 
epidemiological records. We shall be very glad, however, to send you 
future reports along this line from time to time. 

With kindest regards, I am, 

Fraternally yours, 

John J. Sippy, M.D., 

Epidemiologist. 



272 

paper by Miss Wade and Dr. McDaniel on this epidemic. See enclosed 
reprint, "Observations on the Widal Reaction following the Administra- 
tion of Typhoid Vaccine." 

The Faribault school is Institution B. It is a curious thing that the 
only cases of typhoid that have appeared in this school since the epidemic 
reported have been among persons who did not show Widal reaction 
present, although they were said to have been properly vaccinated. 

There is another reference to this epidemic in an article by Dr. Mc- 
Daniel and Miss Wade in the August "Journal of the American Public 
Health Association." I will send you later a reprint of an article by 
Dr. Hill, relating to the spread of typhoid through milk in North Branch, 
Minn. This occurred several years ago, when I was bacteriologist, and 
I had to send away to get reprints, but will have them for you soon. 

In regard to milk in diphtheria, see page 313 of the Laboratory Di- 
vision Report, 1911 to 1913. In addition, for a butter-borne diphtheria 
infection, see page 203 of the Division of Epidemiology report, Aug. 1, 
1910, to Aug. 1, 1912. 

In regard to the length of time that diphtheria bacilli survive in butter, 
Dr. L. P. Pearsall conducted experiments several years ago which showed 
that virulent diphtheria bacilli could be recovered from butter kept 
under various conditions for two to three months. Some of the butter 
from which the bacilli were recovered was so long kept that it was unfit 
for human consumption. 

Regarding milk in scarlet fever, we have records of three epidemics 
where it is probable that milk played a part in the spread of scarlet fever. 
However, I have not given these, since the evidence was not conclusive. 
The epidemic outlined in Summary 76, XIV., was very clear cut. It 
was milk borne without question. 

In regard to septic sore throat, no epidemic has occurred, to our knowl- 
edge, in Minnesota. I may say that in several epidemics which I person- 
ally investigated there was strong circumstantial evidence indicating 
that milk was the main route of infection. However, careful investiga- 
tion proved that appearances were deceptive, for it was readily shown 
that the milk could not have been infected, and the cases suspected to 
be milk infections were traced to direct contact with known cases at a 
time which would account for the infection. 

I am sorry that we have no more definite material for you, but I have 
asked Dr. I. J. Murphy, now executive secretary of the Minnesota Public 
Health Association, but for many years epidemiologist for the Duluth 
city Board of Health, to look up certain milk-borne infections which he 
investigated in Duluth. He promised to do this. When I receive his 
notes I will forward the information. 

A. J. Chesley, 

Director. 



273 



Appendix E. 



INFLUENCE OF PASTEURIZATION ON CHEMICAL CONTENT 

OF MILK. 



BY HERMANN C. LYTHGOE, CHARLES H. HICKEY AND CLARENCE E. MARSH. 



This work was undertaken by reason of the testimony of 
certain commercial chemists in a contested case, to the effect 
that the pasteurization of milk would tend to lower the refractive 
index of the milk serum by causing a hydrolysis of the milk 
sugar and thereby reducing the concentration of the serum to 
such an extent that a sample of normal market milk free from 
added water would be almost certain to be considered adulterated 
when tested by means of the usual methods devised for that 
purpose. These chemists never published this statement, 
probably owing to the fact that careful experiments would show 
its absolute fallacy. 

After the work was completed it was found that in addition to 
solving the problem investigated we had obtained valuable data 
for other considerations. 

In order to show whether or not the influence of heat upon 
lactose solutions caused a reduction in its refractive index, an 
aqueous solution of lactose was divided into two parts, to one of 
which some citric acid was added. Each of these solutions was 
divided into three parts, one of which was connected with a 
return-flow condenser and heated in a boiling water bath for ten 
minutes. Another was heated in a similar manner for forty-five 
minutes, and the third portion was kept at the room tempera- 
ture. It would appear that if any great change in concentration 
due to hydrolysis occurred by heating lactose solutions it would 
be shown by these experiments. The results are shown in 
Table I. 



274 



Table I. — 


• Influence of Heat on Lactose Solutions. 




Temperature 
(Degrees C). 


Refractive 
Index. 


Polarization 

200 millimeters, 

Ventake Scale. 


Lactose solution: — • 














22.5 


43.6 


25.16 






22.5 


43.8 


24.50 






22.5 


43.8 


24.30 


Lactose citric acid solution: 


- 












22.5 


46.3 


24.56 






22.5 


46.4 


24.50 


Heated forty-five minutes, 


• 


22.5 


46.6 


24.54 



These figures show that the boiling of lactose solutions with 
or without the addition of citric acid has practically no influence 
upon the refractive index. 

In order to determine the effect of pasteurization upon milk 
and cream, 20 samples of milk of known purity and 2 samples of 
certified milk were obtained. In collecting the samples of known 
purity milk, the dairies in each instance were visited by one or 
more of us, the cows milked in our presence, and a 6-quart 
sample of the thoroughly mixed milk taken from the mixing 
tank. In two instances, owing to the fact that the mixing tank 
was small and bottling was begun before all the cows were 
milked, 6 1 -quart samples were taken intermittently during the 
bottling in such a manner that the mixture of these samples gave 
a fairly accurate indication of the herd milk. The samples were 
all milked in the evening. The next day the sample was 
thoroughly mixed and two one-half pint portions removed; the 
balance, after warming to blood heat, was passed through the 
separator. The cream was divided into parts and two one-half 
pint samples of the skimmed milk were taken. One sample each 
of the whole milk, skimmed milk and cream were then pasteur- 
ized by placing the bottles in warm water, stirring with a 
thermometer until the desired temperature was attained. The 
bottles were then stoppered and placed in a thermostat heated to 
the temperature of pasteurization, where they were kept for 
thirty minutes or more. In some instances samples were with- 
drawn during the holding process. After the holding period had 
elapsed the samples were cooled. In four instances the whole 



275 

milk was not pasteurized. The raw and pasteurized samples 
were then submitted to analysis, determinations being made in 
most instances of solids, fat, total proteins, ash, lactose, copper 
serum refraction, sour serum refraction and sour serum ash. 
After the refractive index had been determined the serum was 
placed in a test tube, heated in boiling water for five minutes, 
cooled, filtered and the refractive index of the clear filtrate de- 
termined. Owing to the limited quantity of sample, particularly 
of cream, the work could not be done in duplicate; therefore the 
majority of the figures reported are the result of single determi- 
nations. Sample X was treated in a somewhat different manner. 
A one-half pint sample of the whole milk was removed, and 
2\ quarts were passed through the separator in order to obtain 
the raw milk, skimmed milk and cream. The remaining 3 
quarts were pasteurized, and while still hot 2\ quarts were 
passed through the separator in order to obtain the samples of 
pasteurized milk, skimmed milk and cream. The resulting 
cream, therefore, contained a different fat content than that 
obtained from the raw milk, and no attempt was made to adjust 
the raw cream by adding skimmed milk. The results of the 
analyses are given in Table II. 



276 





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280 



It will be seen from a perusal of these tables that heating has 
but little effect upon the percentage of the milk constituents 
estimated other than that caused by a slight concentration. In 
the case of the serum, however, there was a diminution of the 
refractive index due to more or less coagulation of the albumin. 
The maximum and average differences between the milk con- 
stituents are shown in the following table. 



Table III. — Difference between Raw and Pasteurized Samples. 

Milk. 



Solids, 
Fat, . 
Proteins, 
Ash, 
Lactose, 



Maximum Difference. 



Pasteurized 
above — ■ 



0.48 
0.20 
0.05 
0.08 
0.70 



Pasteurized 
below — 



0.06 
0.10 
0.15 
0.09 
0.10 



Average 
pasteurized. 



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0.04 higher 
0.01 lower 
0.003 lower 
0.005 higher 



Skimmed Milk. 



Solids, 
Fat, . 
Proteins, 
Ash. 
Lactose, 




0.095 higher 

0.003 higher 
0.008 lower 
0.036 higher 



Cream. 



Fat, . > 
Proteins, 
Ash, 
Lactose, 




0.045 lower 
0.022 higher 
0.022 higher 
0.018 higher 



Comparison of Serum of Milk, Skimmed Milk and Cream. 

The serum of skimmed milk and of cream is the same as that 
of the whole milk from which it was obtained, although our 
figures in a few instances do not seem to bear out this statement. 
The variations in the refractive index of the sour serum are due, 
no doubt, ( to changes in the character and the duration of the 



281 

fermentation. If the same sample of milk is divided into several 
portions and fermented with different ferments, the refractive 
indices of the serums will be different. The variation in the 
refractive indices of the copper serums made from milk, skimmed 
milk and cream from the same source can be explained, as 
follows: It is a well-known fact that if a sample of milk is 
allowed to set, the bacterial content of the cream is greater than 
that of the skimmed milk. These samples in which the serum 
refraction of the cream was greater than that of the milk were 
obtained under such circumstances that they could not be cooled 
at the time of milking, and were not transferred to the laboratory- 
ice chest for some hours. The following morning it was noticed 
that the cream was slightly sour, although the balance of the 
milk was normal. The samples undoubtedly were not poured 
over sufficiently to make the serum uniform throughout the 
entire mass, although the fat was evenly distributed. As the 
refractive index of the copper serum of milk is higher if the 
serum is prepared after the sample is sour, the apparent dis- 
crepancy is thus accounted for. 

Influence of Pasteurization on Milk Serum. 

The heating of milk has a tendency to produce a diminution 
of the refractive index of those milk serums which contain the 
coagulable albumin. The . higher the temperature the greater 
will be the influence until complete coagulation takes place at 
about 85° C. or 185° F. The coagulation begins at 64° C. or 
147° F., below which apparently it cannot take place in sufficient 
quantity to affect the serum. The refractive index of the copper 
and sour serums, the ash of sour serums and the temperature of 
pasteurization of the samples are given in Table IV. 



282 



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286 



The diminution of the refractive index of the serum by 
pasteurization is influenced by the per cent, of fat in the sample 
as well as by the temperature to which it has been heated. 
Milk with a high fat content has a high protein content, and milk 
with a low fat content has a low protein content. A sample of 
milk containing 5 per cent, fat would contain about 0.7 per cent, 
coagulable albumin. A sample with 4 per cent, fat would con- 
tain about 0.6 per cent, albumin and one with 3 per cent, fat, 
about 0.5 per cent, albumin. The complete coagulation of the 
albumin in a sample of milk from a herd of Jersey cows would 
have more influence in lowering the refractive index of the serum 
than if the sample was obtained from a herd of Holstein cows. 
As the milk with a high fat content gives a more concentrated 
serum than the milk with a low fat content, the influence of 
heating is less marked in the latter case; in fact, the copper 
serum and sour serum prepared from boiled milk is more uniform 
than that prepared from raw milk. The refractive index of the 
average milk would be reduced to an extent of 1.8 scale divisions 
by boiling; therefore with a sample of milk containing 5 per cent, 
fat we should expect a reduction of about 2.1 scale divisions, and 
with a sample containing 3 per cent, fat, a reduction of 1.3 scale 
divisions. The influence of both heat and fat content upon the 
diminution of the refractive index of the copper serum is shown 
in Table V., the figures being obtained from Table IV. 

Table V. 



Numbeb of Analyses. 



5, 
11, 
6, 

3, 

14, 
11, 

9, 
12, 
3, 

11, 

20, 
9, 



Temperatube. 



Degrees C. Degrees F 



176 
176 
176 

167 
167 
167 

165 
165 
165 

158 
158 

158 



Average fat. 



4.05 
3.82 
3.60 

4.70 
3.94 
3.50 

3.95 
3.74 
3.20 

4.05 
3.95 
3.48 



Average Difference 

between Re- 
fraction of Copper 

Serum before 
and after Heating. 



1.70 
1.40 
1.20 

1.11 
1.11 

1.10 

0.90 
0.85 
0.80 

0.73 
0.63 
0.54 



287 



From the figures in Table IV. the relation between the temper- 
ature to which milk is heated and the percentage coagulation of 
the albumin has been computed, and is shown in Table VI. It 
should be understood that these figures are somewhat influenced 
by the duration of time the milk has been kept at the tempera- 
ture specified. 

Table VI. 





Temperature. 


Per Cent, of 

Albumin 
coagulated. 


Temperature. 


Per Cent, of 

Albumin 
coagulated. 


Degrees C. 


Degrees F. 


Degrees C. 


Degrees F. 


60 


140 


- 


75 


167 


60 


65 


149 


10 


77 


171 


70 


67 


153 


20 


78 


172 


80 


69 


156 


30 


79 


174 


90 


71 


160 


40 


80 


176 


100 


73 


163 


50 









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289 

The figures obtained from those samples which were removed 
during the heating and holding process in order to obtain the 
relative rate of reduction of the refractive index of the serum 
are given in tabular form in Table VII. 

Judging from the results obtained from known purity milk 
heated slowly in bulk in the laboratory, we have arrived at the 
conclusion that practically no chemical effect takes place in milk 
upon heating until the temperature of 64° C. or 147° F. has been 
attained. As the temperature increases above this point the 
albumin gradually becomes insoluble, and the refractive index of 
the serum decreases until the temperature reaches 85° C. or 
185° F., above which (up to the boiling point) no further in- 
fluence is apparent. The influence of holding is not so marked 
as that of heating, and the reduction of the refractive index of 
the serum is less a factor of the length of time than of the 
temperature, for if the latter is below 64° C. or 147° F. the time 
of holding is without influence upon the coagulability of the 
albumin. 

Pasteurization is without influence upon the sour serum ash, 
notwithstanding the fact that the heating of milk above 72° C. 
or 161° F. causes the precipitation of some of the calcium salts, 
the exact nature of which is at present a matter of controversy, 
but which is coincident with the destruction of the peroxidases. 
The formation of lactic acid during the souring of the milk 
causes a complete solution of any precipitated mineral matter, 
and consequently the sour serum ash of pasteurized milk is the 
same as that obtained from the raw milk. 

The term pasteurization as used herein has been somewhat of 
a misnomer as it has been applied where the terms cooked, 
boiled or scalded should have been used. Commercial pasteuriza- 
tion is carried out at a temperature of 62.8° C. or 145° F., the 
milk going to holding chambers where it is kept for from thirty 
minutes to one hour. Under these circumstances there is prac- 
tically no coagulation of the albumin, and therefore there is no 
liability of commercial milk giving a serum of lower concentra- 
tion than would be obtained from the same milk before heating. 
If, however, milk has been heated sufficiently to cause any 
marked diminution of the albumin, it may be detected by per- 
forming the peroxidase reaction which will be negative, in which 
instance a lower figure may be selected for the minimum re- 
fractive index. 

After the above experiments had been performed and the 
results compiled, it was decided to investigate the influence of 



290 

commercial pasteurization upon milk. Three pasteurization 
plants near Boston were visited, and samples were taken before 
and after pasteurization. One plant used the flash system, heat- 
ing momentarily to 74.4° C. or 16.6° F., and cooling immediately, 
the entire process from the mixing tank to the bottles taking 
about one-half minute. In this plant two samples were taken 
before and two after pasteurization at such an interval of time 
that the pasteurized samples represented substantially the same 
milk as the corresponding raw samples. The other plants from 
which samples were taken used the holding system, the milk 
being instantaneously heated to 146-147° F. (63.3°-63.9° C), 
transferred to holding chambers with a loss of 3 to 4° F., held 
for a period of thirty minutes with a loss of 1 to 2° F., cooled 
and bottled. Two samples were taken, one each from the mixing 
tank, from the outlet of the cooler and the outlet of the holder 
at such intervals that the raw, heated and held samples were 
from substantially the same milk. In one instance samples were 
also taken from the tank where the pasteurized milk was mixed 
before bottling, and one sample was also taken from the bottling 
machine. The results of the analyses are shown in Table VIII. 



291 



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292 

From these figures it can be a irmed that commercial pasteur- 
ization is without substantial influence upon the chemical com- 
position of milk as determined by the methods described in this 
investigation. * As commercial pasteurized milk is not the ex- 
clusive product of a two or three cow dairy, but represents the 
mixed milk of at least 20 dairies of 15 cows each, there is no 
necessity, for the purpose of measuring the purity of this milk, 
of applying figures obtained from the milk of a few abnormal 
cows which were or may have been afflicted with diseased 
udders. Samples of this variety may possibly be obtained from 
cows which are under forced rations, for the purpose of obtaining 
a heavy flow of milk for advanced registry. It is a notable fact 
that cows that have undergone such treatment have more or less 
udder troubles, and may not subsequently give normal milk. 
Commercial pasteurized milk should be compared with the milk 
from herds of 15 or more cows, and if the analytical constants 
and ratios are outside of what under these circumstances would 
be expected, the sample is adulterated, even if it conforms to 
analyses of many samples of abnormal milk from individual cows. 

Conclusions. 

The serum of milk, skimmed milk and cream from the same 
source is identical. Commercial pasteurization is without 
influence upon the components of milk as determined by the 
methods employed in this investigation. Heating milk to a 
temperature of 150° F. or 65° C. and above for a period of three 
minutes or more will cause a coagulation of the albumin, and 
consequently a diminution in the concentration of the serum. 
Commercial pasteurization being always applied to large volumes 
of milk representing the mixed milk of many herds, it is not 
essential to use, in judging the quality of such milk, the data 
obtained from individual cows, but rather from herds. Heating 
is without influence upon the ash of the serum of sour milk, or 
of the acetic acid serum of milk. 

The thanks of the authors are extended to Miss Katherine E. 
Rooney, assistant analyst of the State Department of Health, 
for analytical work in connection with the investigation of the 
commercial pasteurizing process, and particularly for making the 
bacteria counts. 



293 



Appendix F. 



STATUS OF LOCAL MILK INSPECTION. 

The data presented in the following pages were obtained, first, 
from the questionnaire submitted to local boards of health in the 
spring of 1915; second, from the information gathered by the 
Food and Drug Division in personal visits to local milk in- 
spectors and agents of local boards of health in the summer of 
1915; and third, from repeated correspondence with local boards 
of ^health, in which fewer and simpler questions were asked than 
in the questionnaire, in the early autumn of 1915. The State 
Department of Health owes its sincere thanks to those employees 
of local boards of health who have so kindly and accurately 
answered the questions submitted to them, and also to those 
who so willingly permitted access to their official records. It is 
believed that the compilation is as complete as it is possible to 
obtain, and your Board has on file all the data which it has 
been able to collect in this State relative to local milk inspection, 
from which data this compilation has been made. 

The varied character of the work done by different local 
boards of health has rendered it advisable to not only present 
the compilation alphabetically by 'cities and towns, but also to 
divide the cities and towns into sections according to the 
character of the work done. The first attempt resulted in 25 
sections, but after several efforts it was found to be possible to 
present the data in 16 sections. These sections are arranged in 
the order of the importance of the work done, and are as fol- 
lows: — 

Section 1. — Cities and towns granting licenses and permits, inspecting 
dairies and making chemical and bacteriological examinations of milk. 

Section 2. — Cities and towns granting licenses and permits, inspecting 
dairies and making chemical examinations. 

Section 3. — Cities and towns having milk inspectors who grant licenses, 
inspect dairies and make chemical and bacteriological examinations. 

Section 4- — Cities and towns granting licenses or permits, inspecting 
dairies and making chemical and bacteriological examinations. 

Section 5. — Cities and towns granting licenses and making chemical 
and bacteriological examinations. 



294 

Section 6. — Cities and towns making chemical and bacteriological 
examinations only. 

Section 7. — Cities and towns granting licenses and permits, inspecting 
dairies and making bacteriological examinations. 

Section 8. — Cities and towns granting licenses, inspecting dairies and 
making chemical examinations. 

Section 9. — Cities and towns granting licenses and making chemical 
examinations. 

Section 10.— Cities and towns granting licenses or permits and in- 
specting dairies. 

Section 11. — Cities and towns having a milk inspector and granting 
licenses only. 

Section 12. — Cities and towns in which the inspector was recently 
appointed. No work done other than the granting of a ,few licenses or 
permits. 

Section IS. — Miscellaneous. 

Section 14- — Cities and towns having an inspector from whom no 
reply could be obtained. 

Section 15. — Cities and towns doing no milk work under the milk in- 
spection laws. 

Section 16. — Cities and towns from which no information could be 
obtained. 

Section 1 comprises 17 cities and towns which carry out the 
law as the statutes contemplate. From the data given it may 
be easily ascertained how extensively this work is performed. A 
bacteriologist can easily make from 50 to 100 bacteria counts per 
day, and a competent chemist can easily make from 30 to 50 
chemical examinations of milk per day. A dairy inspector 
cannot, as a rule, make more than 15 dairy inspections per day 
if carefully carried out. In order to effectively supervise the 
milk supply of a locality, at least one chemical examination and 
one bacteriological examination should be made each month of 
the milk of each dealer. Several samples should be taken at 
each inspection. This work requires the services of trained men, 
and many localities cannot afford the necessary expense. 

The cities and towns listed under section 2 carry out the 
statutory provisions relative to milk inspection, but make no 
bacteriological examinations as do those localities of section 1, 
under their statutory powers to make and enforce bacteriological 
rules and regulations. 

The 22 localities in section 3 effectively protect their communi- 
ties by the quality of the work performed, but do not grant 
permits as required by the statutes. 



295 

The 5 towns listed in section 4 perform work almost essential 
in character to those in section 1, but both licenses and permits 
are not issued. 

The 3 towns listed in section 5 do not enforce dairy inspection 
and permit laws, but if the work done is performed frequently 
and properly it affords good protection to the inhabitants. 

Section 6, with the exception of licensing the dealers, is doing 
work equivalent to those localities recorded under section 3. 

Section 7 consists of 3 towns which are carrying out all the 
statutory requirements except the making of chemical examina- 
tions for the detection of adulterations. 

Section 8, comprising 5 localities, makes no bacteriological 
examinations and issues no permits. The dairy inspections, as a 
rule, are confined to local dairies. 

Section 9 comprises 3 localities, 2 of them being large cities 
which license the milk dealers and make chemical examina- 
tions. 

Section 10 comprises 79 cities and towns, and is the largest 
section except that doing no milk work. It is substantially 
carrying out the provisions of chapter 744 of the Acts of 1914 
relative to dairy inspection. Most of these localities raise their 
own milk supply, and as the dairies inspected were but few, the 
records of inspection were not investigated excepting those 
instances where a large number of dairies were reported to have 
been inspected. In some instances, however, the dairy inspection 
was confined to local dairies when the locality imported milk. 
The dairy inspections were made, in many instances, by the 
inspector of animals which, while not strictly conforming to the 
requirements of the statutes, were no doubt done as well as if a 
special inspector had been appointed for the purpose. In other 
instances the members of the board of selectmen or the board of 
health performed the inspection work. 

Section 11 consists of 13 localities which have milk inspectors 
and grant licenses. 

Section 12 comprises 8 towns which have recently appointed 
an inspector of milk. No work has been done other than the 
granting of a few licenses or permits. 

Section 13 comprises 7 localities which are classed as miscel- 
laneous. These localities grant a few permits and one license. 

Section 14 comprises 4 towns having a milk inspector from 
whom no replies could be received from a letter asking for 
information regarding the character of work done. 



296 

Section 15 is the largest section and comprises 159 localities 
doing no work under the milk inspection laws. 

Section 16 comprises 10 towns from which no information 
could be received in response to numerous inquiries. No doubt 
these 10 towns belong in group 15, which would raise the 
number of towns doing no work to 172. 

The figures obtained from these cities and towns Were col- 
lected between May and November during the year 1915. Most 
localities doing work were eager to allow access to their records, 
and were therefore investigated early in the year. The figures 
for dairy inspection obtained from these cities and towns are, 
therefore, much lower than they would have been had they been 
collected in October, because the prevalence of the hoof and 
mouth disease during the winter of 1914-15 had the effect of 
curtailing the inspection of dairies. This was not resumed until 
late in the spring of 1915. In fact, many localities did not 
begin operations under the dairy inspection law of 1914 until 
the summer of 1915. 

In the preparation of this portion of the report for the printer, 
it was decided to submit to each city and town a statement of 
what the Department proposed to print. Therefore a letter was 
sent stating this fact, enclosing a form upon which was stated 
the name of the State or town, the number of licenses, permits 
and dairies inspected in 1914 and 1915, the character of the 
dairy inspection, a statement of the records of dairy inspection, 
the number of chemical examinations, and the number of bac- 
teriological examinations. The city or town to which this letter 
was sent was requested to return the statement saying that it 
was correct, or to return it stating that it was in error, with a 
statement of how the corrected report should read. After these 
replies had been received it was ascertained that in a few in- 
stances there was a discrepancy between the reports of records 
of dairy inspection as brought back by our own investigators 
and as claimed by the local men. In these instances the local 
men were unable at the time of visits to show any records of 
their dairy inspections to the Department's employees. A few 
of the local men have claimed that this was in error, and that 
they have records on file in the office. Many of the local men, 
however, admit the correctness of our statements that they had 
no records of dairy inspection. A large number of cities and 
towns have made no reply to this last letter submitted. 



297 



(A) Summary of Local Milk Inspection, classified by 
Cities and Towns. 

Section 1. Cities and Towns granting Licenses and Permits, in- 
specting Dairies and making Chemical and Bacteriological 
Examinations. 

Amherst. 

16 licenses granted. 

16 permits granted. 

10 dairies inspected. 
120 chemical examinations made. 
120 bacteriological examinations made. 

Boston. 
5,381 licenses granted. 

Permits at present being granted. 
7,323 dairies inspected. 
15,150 chemical examinations made. 

6,834 bacteriological examinations made. Records not investigated by 
reason of the difficulty of the task. 

Braintree. 

31 licenses granted. 

21 permits granted. 

31 dairies inspected. The dairies are located in Braintree, Randolph 
and Weymouth. Dairies of the Barden Cream Company not 
investigated. Dairy inspection made for general cleanliness and 
recorded as fair, passed, good, etc. 

36 chemical examinations made. 

12 bacteriological examinations made. 

Brockton. 
462 licenses granted. 
192 permits granted. 

242 dairies inspected, located in Avon, Brockton, Stoughton; Bridge- 
water, Abington, East Bridgewater and Randolph. Some of 
these dairies scored exceptionaUy low, the average of all the 
dairies being slightly below 50. The bacterial analyses show 
the milk sold to be of good quality. 
1,524 chemical examinations made. 
2,080 bacteriological examinations made. 



298 



Brookline. 

140 licenses granted. 

339 permits granted. 

354 dairies inspected. Dairy inspection made on special score card. 
Brookline has inspected the dairies of the large contractors lo- 
cated in New Hampshire, Vermont, Maine and western Massa- 
chusetts, and has inspected nearly all the dairies of the smaller 
dealers. The contractors are obliged to furnish milk from special 
dairies approved by the agent of the board of health. In doing 
this work the territory covered by Boston and Newton has been 
duplicated. Some of the inspections have been made in col- 
laboration with the Newton Board of Health. 

470 chemical examinations made. 

534 bacteriological examinations made. 

Fall River. 

741 licenses granted. 

407 permits granted. 

412 dairies inspected. The dairies are located in Berkley, Dighton, 
Fall River, Dartmouth, Somerset, Swansea, Rehoboth, Tiverton, 
R. I., Portsmouth, R. I., Little Compton, R. I., and Warren, 
R. I. There does not seem to be any duplication of the work by 
other cities or towns in making these inspections. 

214 chemical examinations made. 
2,286 bacteriological examinations made. 

Haverhill. 
42 licenses granted. 
110 permits granted. 

26 dairies inspected, located in Haverhill and Bradford. No attempt 
made to inspect dairies outside of the city except one dairy in 
Salem, N. H. Considerable cream sold by Turner Centre Dairy- 
ing Association. Dairies not inspected. 
314 chemical examinations made. 
2,103 bacteriological examinations made. 

Lancaster. 
9 licenses granted. 
40 permits granted. 

48 dairies in Lancaster inspected. United States score cards used. 
19 chemical examinations made. 
32 bacteriological examinations made. 



299 



Lawrence. 
82 licenses granted. 
42 permits granted. 
175 dairies inspected, located in Methuen, Andover, North Andover 

and Dracut. Inspection made for general cleanliness. 
217 chemical examinations made. 
125 bacteriological examinations made. 

Milton. 
36 licenses granted. A few permits granted. 

25 dairies inspected. Score card used in inspecting dairies located in 
Milton. Dairies of the H. P. Hood Company, the Elm Farm 
Company and Barden Cream Company not known or inspected. 
297 chemical examinations made. 
103 bacteriological examinations made. 

Natick. 
57 licenses granted. 
65 permits granted. 
76 dairies inspected, located in Sherborn, Framingham, Ashland, Hol- 

liston, Wayland, Dover, Sudbury and Natick. 
30 chemical examinations made. 
4 bacteriological examinations made. 

Newton. 

178 licenses granted. 

435 permits granted. .. 

666 dairies inspected. Dairies located around Newton, and contractors' 
dairies in New Hampshire, Vermont and western Massachusetts. 
Inspections made by United States score cards and records kept. 
Work of the Boston Board of Health and Brookline Board of 
Health has been duplicated by Newton. Some of the inspections, 
however, have been made in collaboration with the Brookline 
Board of Health. 

821 chemical examinations made. 

198 bacteriological examinations made. 

Somerville. 

610 licenses granted. 

336 permits granted. 

354 dairies inspected. Dairies of large contractors not inspected. Some 
of the out-of-State dairies of the smaller contractors inspected, 
going over the territory covered by Newton, Brookline and 



300 

Boston. Inspection scores of the State accepted, and also in- 
spections of Boston, Waltham and Arlington when available. 
The inspector relies more upon microscopical examination and 
bacteria count of milk than upon dairy inspection. 

3,008 chemical examinations made. 

1,143 bacteriological examinations made. 

Springfield. 
732 licenses granted. 
78 permits granted. Permits have been issued by regulations of the 
city Board of Health before the passage of the 1914 law. New 
permits issued during 1914. 
997 dairies inspected. Dairies were inspected by the score card method, 
the Department covering practically all the dairies supplying 
milk to the city. Dairies are located in Agawam, ' Amherst, 
Becket, Deerfield, Enfield, Granby, Greenfield, Greenwich, Had- 
ley, Hampden, Hardwick, Huntington, Longmeadow, Ludlow, 
Middlefield, Monson, Montgomery, Palmer, Prescott, Savoy, 
Southwick, Warren, Washington, Westfield, West Springfield, 
Whately, Wilbraham and in Ellington, Hazardville, Somers and 
Suffield, Conn. Springfield reports that the milk from many of 
these dairies, which was refused admission to Springfield, is be- 
ing sold in surrounding towns. No other cities or towns have 
inspected these dairies to the knowledge of the Springfield Board 
/ of Health. The territory, however, where the dairies are located 
has been covered by inspectors of other cities or towns. 
2,$97 chemical examinations made. 
1,120 bacteriological examinations made. 

Westfield. 

17 licenses granted. 

57 permits granted. 
110 dairies inspected. 
204 chemical examinations made. 

23 bacteriological examinations made. 

Winchendon. 

34 licenses granted. 
28 permits granted. 

207 dairies inspected. Dairies located in Winchendon. Inspections 

made by means of United States score card. 
297 chemical examinations made consisting of fat and sediment tests. 

35 bacteriological examinations made. 



301 



Winchester. 
49 licenses granted. 
38 permits granted. 

92 dairies inspected. Inspection made by United States score card 
method of dairies located in Woburn, Stoneham, Winchester, 
Short Falls, N. H., Wilton, N. H., and Milford, N. H. The 
extra-State dairies supply milk to Hood and Whiting. 
165 chemical examinations made. 
165 bacteriological examinations made. 



Section 2. Cities and Towns gkanting Licenses and Permits, 
inspecting Dairies and making Chemical Examinations. 

Amesbury. 
6,3 licenses granted. 
42 permits granted. 
92 dairies inspected. Dairy inspection consists of examination for 

general cleanliness. 
29 chemical examinations made. Chemical examination for fat only. 



Arlington. 
82 licenses granted. 
12 permits granted. 
90 dairies inspected. 
200 chemical examinations made. 



Athol. 
20 licenses granted. 
20 permits granted. 

30 dairies inspected. Dairies inspected for general cleanliness. Rec- 
ords show dairies to be good or poor. 
24 chemical examinations for fat. 

Barnstable. 
167 licenses granted. 
126 permits granted. 
169 dairies inspected. 

80 chemical examinations consisting of fat and specific gravity. Ex- 
aminations made for general cleanliness. Rules and regulations 
of the board of health require all dealers to obtain licenses and 
pay for the same. 



302 



Chicopee. 
112 licenses granted. 
62 permits granted. 

62 dairies inspected. Special card used for inspection on general clean- 
liness. 
285 chemical examinations consisting of fat determination. 

Greenfield. 

20 licenses granted. 

20 permits granted. 

35 dairies inspected. Dairies inspected twice a year for general clean- 
liness. Score card occasionally used. 

90 chemical examinations made. Chemical examinations consist of 
specific gravity and fat. 

Hingham. 
10 licenses granted. 
20 permits granted. 

20 dairies inspected. Dairy inspection of general cleanliness confined 
to dairies in town. 
1 chemical examination made. 

Hull. 
30 licenses granted. 
4 permits granted. 

4 dairies inspected. Dairy inspection made for general cleanliness. 

( Inspector does not know from how many dairies the town obtains 

its milk. Dairies of the Deerfoot Farm and Whiting have not 

been inspected. 

70 chemical examinations made. Chemical examinations consist of 

fat determination. 

Montague. 
26 licenses granted. 
26 permits granted. 

4 dairies inspected. 

5 or 6 chemical examinations made. 

North Adams. 
89 licenses granted. 
75 permits granted. 

182 dairies inspected. United States score card used in inspecting 
dairies. Dairies are scored in the spring and fall. Nearly all the 
dairies have been inspected. 
340 chemical examinations for fat. 



303 



Provincetown. 
30 licenses granted. 
39 permits granted. 

21 dairies inspected, located in Provincetown and Truro. General 

inspection made and also United States score card used. In- 
spection made by the State at the request of the Provincetown 
Board of Health. 
14 chemical examinations made. 

Wakefield. 

22 licenses granted. 
22 permits granted. 

, 12 dairies inspected. Dairies located in Exeter and Epping, N. H., 

North Reading, Lynnfield, Wakefield and Melrose. 
100 chemical examinations made. 

Ware. 
55 licenses granted. 
64 permits granted. 
142 dairies inspected. Dairies inspected every three months but not 

scored. 
488 chemical examinations for fat. 

Woburn. 
107 licenses granted. 

105 permits granted to those taking out licenses. 
Ill dairies inspected. Dairies of D. Whiting & Co. not inspected. 
Ill chemical examinations made consisting of fat and specific gravity. 

Section 3. Cities and Towns having Milk Inspectoks who grant 
Licenses, inspect Dairies and make Chemical and Bacterio- 
logical Examinations. 

Belmont. 
41 licenses granted. 

61 dairies inspected, located in 10 different cities and towns in the 
State. 
230 chemical examinations made. 
230 bacteriological examinations made. 
Records not investigated. 

Cambridge. 
700 licenses granted 
23 dairies (local) inspected. 
2,300 chemical examinations made. 
842 'bacteriological examinations made. 



304 



Canton. 
25 licenses granted. 

Permits granted on strength of previous year's examination. 
29 dairies inspected, located in Canton and Stoughton. 
209 chemical examinations made. 
228 bacteriological examinations made. 

Chelsea. 
261 licenses granted. 
18 dairies inspected. Inspection limited to local dairies. The bulk of 
the milk sold in Chelsea comes from the large contractors. 
226 chemical examinations made. 
61 bacteriological examinations made. 

Cohasset. 
12 licenses granted. 

6 dairies inspected, located in Cohasset and Scituate. 
10 chemical examinations made. 
29 bacteriological examinations made. 

Concord. 
15 licenses granted. 
15 dairies inspected, located in Concord and Littleton. 

5 chemical examinations made. 

1 bacteriological examination made. * 

Dedham. 
24 licenses granted. 
51 dairies inspected, located in Dedham, Westwood, Norwood, Dover 

and Needham. 
226 chemical examinations made. 
51 bacteriological examinations made. 

Fitchburg. 
110 licenses granted. 
114 dairies inspected. 
377 chemical examinations made. 
76 bacteriological examinations made. 

Framingham. 
29 licenses granted. 

87 dairies inspected, located in Framingham, Holhston, Ashland, Sud- 
bury and Wayland. 
150 chemical examinations made. 
232 bacteriological examinations made. 



305 



Gardner. 
' 43 licenses granted. 
120 dairies inspected, located in Gardner, Winchendon, Ashburnham, 
Westminster, Hubbardston, Templeton, Phillipston, East Jaf- 
.frey, N. H., and East Rindge, N. H. 
379 chemical examinations made. 
48 bacteriological examinations made. 

Holyoke. 
454 licenses granted. 20 permits refused. 

265 dairies inspected, located in Holyoke, Amherst, Sunderland, West- 
field, Southampton, Hadley, Granby, Belchertown, South Deer- 
field, Whately and Hatfield. These inspections, however, were 
made by the State Department of Health at the request of the 
Holyoke Board of Health. Local board now making all dairy 
inspections. 
2,543 chemical examinations made. 
40 bacteriological examinations made. 



Lynn. 
587 licenses granted. 
1,034 dairies inspected, located in cities and towns surrounding Lynn, 
dairies in Maine including Auburn and Lewiston, also dairies in 
the neighborhood of, Portsmouth, N. H. General inspection of 
dairies show the dairy to be good, fair and poor. 
2,024 chemical examinations made. 
320 bacteriological examinations made. 



Maiden. 
261 licenses granted. 
190 dairies inspected; 75 per cent, of the milk comes from out of the 

State, and the dairies have not been inspected by the city of 

Maiden. 
563 chemical examinations made. 
103 bacteriological examinations made. 

Medford. 
183 licenses granted. 
15 dairies inspected. 
237 chemical examinations made. 
3 bacteriological examinations made. 



306 



Melrose. 
71 licenses granted. 

45 dairies inspected, located in Melrose, Saugus, Wakefield, Reading 
and Wilmington. The large contractors furnish about one- 
quarter of the milk supply, and these dairies have not been in- 
spected. 
285 chemical examinations made. 
356 bacteriological examinations made. 

New Bedford. 
452 licenses granted. 

181 dairies inspected. The inspection limited to local dairies except in 
rare cases. Score card used, records as shown refer to dairies as 
good, fair, etc. 
24 chemical examinations made. 
698 bacteriological examinations made. 

Quincy. 
193 licenses granted. 

68 dairies inspected located in Quincy. Dairies of the large contractors 
not inspected; recorded aS good, fair, poor, very poor, etc. Some 
marked "very poor" are apparently selling milk. 
8 chemical examinations made. 
8 bacteriological examinations made. 

Revere. 
18 licenses granted. 

8 local dairies inspected for general sanitary conditions. Dairies of 
large contractors who furnish most of the milk not inspected. 
124 chemical examinations made. 
62 bacteriological examinations made. 

Salem. 
239 licenses granted. 
80 dairies inspected. United States score card used in inspecting 

dairies. 
874 chemical examinations made. 
874 bacteriological examinations made. 

Taunton. 
84 licenses granted. 
195 dairies inspected, located in Taunton, Dighton, Berkley, Raynham, 

Norton and Rehoboth; recorded as good, fair, etc. 
100 chemical examinations for fat. 
75 bacteriological examinations made. 



307 

Waltham. 
152 licenses granted. 

180 dairies inspected, located in Waltham, Lexington, Lincoln, Bed- 
ford, Wilmington, Weston, Wayland, Sudbury, Stow, Box- 
borough, Harvard, Littleton, Acton and Groton. 
1,400 chemical examinations made. 
427 bacteriological examinations made. 

Worcester. 
193 licenses granted. 

200 dairies inspected. United States score card used. 
1,653 chemical examinations made. 
281 bacteriological examinations made. 



Section 4. Cities and Towns granting Licenses or Permits, in- 
specting Dairies and making Chemical and Bacteriological 
Examinations. 

Clinton. 

53 licenses granted. 

66 dairies inspected. United States score card used. Good records. 
50 chemical examinations made. 
133 bacteriological examinations made. 

Watertown. 

72 licenses granted. 

27 dairies inspected. 
339 chemical examinations made. 
113 bacteriological examinations made. 

Wellesley. 
34 licenses granted. 
43 dairies inspected. 
87 chemical examinations made. 
153 bacteriological examinations made. 

Wesiborough. 
55 permits granted. 

55 dairies inspected. Inspector is a veterinarian. 
20 chemical examinations made. Chemical examinations limited to 

fat, specific gravity and sediment test. 
25 bacteriological examinations made. 



308 



Weston. 
. 13 licenses granted. 
24 dairies inspected. 

43 chemical examinations made. 

125 bacteriological examinations made. 

Section 5. Cities and Towns granting Licenses and making Chem- 
ical and Bacteriological Examinations. 

Needham. 
11 licenses granted. 
48 chemical examinations made. 
87 bacteriological examinations made. 

Swampscott. 

44 licenses issued.. 

58 chemical examinations made. 

24 bacteriological examinations made. 

Winthrop. 

51 licenses granted. 

130 chemical and bacteriological examinations made. 

Section 6. Cities and Towns making Chemical and Bacteriological 
Examinations only. 

Walpole. 
35 chemical examinations made. 
35 bacteriological examinations made. 

Section 7. Cities and Towns granting Licenses and Permits, in- 
specting Dairies and making Bacteriological Examinations. 

Scituate. 
16 licenses granted. 
22 permits granted. 
7 dairies inspected, location in Scituate. General inspection made. 

Records show dairies to be very good or good. 
7 bacteriological examinations made. 

Stoneham. 
50 licenses granted. 

52 permits granted. 

18 dairies inspected. Dairies of large contractors not inspected. 
100 bacteriological examinations made. 



309 



Whitman. 
17 licenses granted. 
27 permits granted. 
32 dairies inspected. Dairy inspection made for general cleanliness. 

Records show dairies to be good, poor or fair. 
38 bacteriological examinations made. 



Section 8. Cities and Towns granting Licenses, inspecting Dairies 
and making Chemical Examinations. 

Adams. 
26 licenses granted. 

45 dairies inspected. Dairy inspection for general cleanliness. 
150 chemical examinations for fat. 

Attleboro. 

32 licenses granted. 

65 dairies inspected. Dairy inspection carried on by United States 
score card. Records shown to investigator. Laboratory appa- 
ratus consisting of babcock machine, balance platinum dishes. 

33 chemical examinations made. 

Beverly. 
164 licenses granted. 

34 dairies inspected. Unable to state from how many different dairies 

the city obtains its milk. 
64 chemical examinations made. . 



Lexington. 
44 licenses granted. 
20 dairies inspected. 
100 chemical examinations made. 

Pittsfield. 
68 licenses granted. 

40 dairies inspected. Dairy inspection consists of inspection for gen- 
eral cleanliness. Recorded as fair, bad and good. Dairy inspec- 
tion confined to Pittsfield. 
300 chemical examinations for fat. 



310 



Section 9. Cities and Towns granting Licenses and making Chem- 
ical Examinations. 

Everett. 
335 licenses granted. 
700 chemical examinations made. 

Lowell. 
600 licenses granted. 
2,226 chemical examinations made. 

Plainville. 
9 licenses granted. 
48 chemical examinations for fat. 

Section 10. Cities and Towns granting Licenses or Permits and 
1 inspecting Dairies. 

Acton. 
16 licenses granted. 
16 permits granted. 

16 dairies inspected. 

Acushnet. 
4 licenses granted. 
14 permits granted. 
14 dairies inspected. 

Inspector appointed May 10, 191.4. 

v Ashby. 

3 permits granted. 
3 dairies inspected. 

Ashland. 

17 permits granted. 

14 dairies inspected, located in Ashland and Hopkinton. 



21 permits granted. 
24 dairies inspected. 

32 permits granted. 
32 dairies inspected. 



Avon. 



Bane. 



Belchertown. 



3 permits granted. 

3 dairies inspected. Records not investigated. 



311 



Bellingham. 
2 permits granted. 
5 dairies inspected. Records not investigated. 

Boxford. 
13 permits granted. 
13 dairies inspected. Records not investigated. 

Bridgewater. 
21 licenses granted. 

4 permits granted. 

8 dairies inspected, located in Bridgewater. Most of the dairies in- 
spected reported as clean, fairly clean, etc. 

Buckland. 
7 permits granted. 
7 dairies inspected. Records not investigated. 

Charlemont. 

5 permits granted. 
5 dairies inspected. 

Chilmark. 
20 permits granted. 
20 dairies inspected. General inspection passable or not passable. 

Conway. 
1 license granted. 
1 permit granted. 
1 dairy inspected. 

Ballon. 
3 licenses granted. 
10 permits granted. 
12 dairies inspected. United States scoreboards used. 

Dana. 
7 permits granted. 
7 dairies inspected. General inspection. 

Danvers. 
51 licenses granted. 
58 permits granted. 
60 dairies inspected. 

Dover. 
10 permits granted. 
10 dairies inspected. Inspection made for general cleanliness. 



312 



Duxbury. 
94 permits granted. 

94 dairies inspected. Dairies inspected by United States score- card 
and records kept. Nearly all the dealers have permits. 

East Longmeadow. 
3 licenses granted. 
14 dairies inspected. 

38 permits granted. 
38 dairies inspected. 

17 licenses granted. 
7 dairies inspected. 

Edgartown. 
26 permits granted. 

26 dairies inspected. Inspection made in collaboration with Dairy 
Bureau. 

Foxborough. 
29 permits granted. 
25 dairies inspected. Records not investigated. 



Eastham. 



Easthampton. 



Gloucester. 
123 licenses granted. 
44 permits granted. 

112 dairies inspected, located in Gloucester, Rockport, Essex, Ipswich 
and Manchester. 

Gosnold. 
4 permits granted. 
4 dairies inspected. 

Great Barrington. 
18 licenses granted. 
24 dairies inspected. 

Inspection made by means of score card. 



77 permits granted. 
77 dairies inspected. 

11 licenses granted. 

4 permits granted. 

11 dairies inspected. 

11 dairies inspected. 



Groton. 



Halifax. 



Hamilton. 



313 



Hanson. 



Holland. 



HopMnton. 



Hudson. 



10 permits granted. 

10 dairies inspected. 

2 or 3 licenses granted. 
2 or 3 dairies inspected. 

54 permits granted. 
44 dairies inspected. 

14 licenses granted. 
14 dairies inspected. 

Ipswich. 

29 licenses granted. 

46 dairies inspected. Inspection for general cleanliness. 

Lee. 
Number of permits issued not recorded. 
175 dairies inspected. Inspection made for general cleanliness. 

Lenox. 

11 licenses granted. 

24 dairies inspected. The dairies are scored for general cleanliness. 
The inspector is also a policeman. 

Ludlow. 

30 licenses granted. 
60 permits granted. 

60 dairies inspected. Town obtains milk from 8 different towns, but 
all of these dairies have been inspected by the Springfield Board 
of Health. 

Marblehead. 
79 licenses granted. 

27 local dairies inspected. Dairies visited two or three times a year. 
Score card used in making inspections. Only local dairies in- 
spected. 

Marion. 
10 permits granted. 
5 dairies inspected. 

Marlborough. 
73 licenses granted. 
10 dairies inspected. 
The city obtains its milk from 55 different dairies, and also obtains 
milk from the Deerfoot Farm. 



314 



Maynard. 
11 licenses granted. 

25 dairies inspected. Recommendations made to dairymen at the 

time of visit. 

Medway. 
34 permits granted. 
34 dairies inspected. Records not investigated. 

Middleborough. 
85 licenses and permits granted. 
88 dairies inspected. 

Millis. 
3 permits granted. 
3 dairies inspected. Records not investigated. 

Monson. 
10 licenses granted. 
3 dairies inspected. 

Nantucket. 
37 licenses granted. 
37 permits granted. 

26 dairies inspected, located in Nantucket. 



50 licenses granted. 
12 permits granted. 
58 dairies inspected. 

7 licenses granted. 
16 permits granted. 
20 dairies inspected. 

33 permits granted. 
29 dairies inspected. 



North Attleborough. 

North Brookfield. 

North Reading. 
Northampton. 



55 licenses granted. 
114 permits granted. 
125 dairies inspected, located in Northampton and surrounding towns. 

Inspections made by United States score cards and complete 

records available. 

Norton. 
130 permits granted. 
130 dairies inspected. 



315 



Norwell. 
65 permits granted. 
65 dairies inspected. Score cards used. 

Norwood. 
4 licenses granted. 
43 permits granted. 

43 dairies inspected, located in Norwood. Inspection made by United 
States score cards and records available. 

Orange. 
36 permits granted. 

36 dairies inspected. General inspection for cleanliness. Recorded as 
passed or not passed. 

Orleans. 
50 permits granted. 

50 dairies inspected. Records not investigated. 

Palmer. . 
70 licenses granted. 
70 permits granted. 

135 dairies inspected, located in Palmer, Belchertown, Monson and 
Ware. General inspection made and dairies recorded as fair, 
good or bad. 

Peabody. 
98 licenses granted. 
19 permits granted. 

100 dairies inspected. No data kept of inspection; figures given to the 
investigator entirely from memory. Dairies inspected are lo- 
cated in Peabody. 

Petersham. 
8 permits granted. 
24 dairies inspected. United States score cards used. Records of 
scores on file. 

Plymouth. 

51 licenses granted. 
60 dairies inspected. 



41 permits granted. 
41 dairies inspected. 

r 26 licenses granted. 
18 dairies inspected. 



Rowley. 
Salisbury. 



316 



Sandwich. 

10 permits granted. 

20 dairies inspected. Inspection for general cleanliness made. 

Saugus. 
59 licenses granted. 
59 permits granted. 
43 local dairies inspected. Inspections made for general cleanliness. 

Sherborn. 
94 licenses granted. \ 

94 dairies inspected. Records not investigated. 

Shirley. 

11 permits granted. 
11 dairies inspected. 

Somerset. 

1 license granted. 

All dairies inspected. 

Southbridge. 

29 licenses granted. 
37 permits granted. 

30 dairies inspected. Dairy inspections made by United States score 

cards. Dairies located in Sturbridge, Charlton, Southbridge. 
Records on file. 

Spencer. 
16 licenses granted. 
27 permits granted. 

27 dairies inspected, located in Spencer and Leicester. Records of 
inspection not investigated. 

Stockbridge. 
19 licenses granted. 
19 permits granted. 
19 dairies inspected. 

Stoughton. 

2 licenses granted. 

31 permits granted. 

33 dairies inspected. One dairy located in Sharon, the balance in 
Stoughton. Four dairies reported in bad condition. Records 
not shown to investigator. 



317 



Sturbridge. 
20 permits granted. 

Records not investigated. 

■ Sunderland. 
2 permit's granted. 
2 dairies inspected. 

Uxbridge. 
5 permits granted. 
5 dairies inspected. Records not investigated. 

Wareham. 
26 licenses granted. 
81 permits granted. 
80 dairies inspected by inspector of animals. 

West Boylston. 
4 permits granted. 
7 dairies inspected. Records not investigated. 



15 permits granted. 
15 dairies inspected. 

8 licenses granted. 
24 permits granted. 
24 dairies inspected. 

24 permits granted. 
19 dairies inspected. 



Westport. 



Williamstown. 



Wilmington. 



Section 11. Cities and Towns having a Milk Inspector and grant- 
ing Licenses only. 



Andover. 

Ashburnham. 

Ayer. 

Fairhaven. 

Falmouth. 

Leominster. 

Methuen. 



Rockland. 

Topsfield. 

Warren. 

West Springfield. 

Westwood. 

Weymouth. 



318 



Section 12. Cities and Towns in which the Inspector was recently 
appointed. No Work done Other than the Granting of a Few 
Licenses or Permits. 

Billerica. 
Inspector recently appointed. Records not investigated. 

Franklin. 
Milk inspector reports that no work has been done. Inspector 
appointed during the summer of 1915. 

Grafton. . 
Inspector appointed during the summer of 1915. 
8 dairies inspected. 

Lunenburg. 
No licenses or permits granted. No dairies inspected. Inspector 
stated that no appropriation was made to carry out the work. 

Marshfield. 
Inspector appointed in the spring of 1915 and has done no work. 

Northborough. 
Inspector recently appointed. No work done. 

Pepperell. 
12 licenses granted. 
12 permits granted. Records not investigated. 

Randolph. 
Inspector recently appointed. 

Section 13. Miscellaneous. 

Becket. 
No inspector. 
1 license granted. Records not investigated. 

Milford. 
Some dairies inspected. 

Newburyport. 
44 licenses granted. 
400 bacteriological examinations made. 



319 







Plyrr 


ipton. 






18 permits 


granted. 


Rowe. 




10 dairies inspected. 










Southampton. 


No inspector. 






4 permits 


granted. 


Upton. 




7 permits 


.. No dairies inspected. 




Section 14. Cities and Towns having an Inspector from whom no 




Reply could be obtained. 


Carlisle. 








South Hadley. 


Rutland. 








Sutton. 


Section 15. 


Cities and Towns doinc 


r no Milk Work under the 




• 


Milk Inspection Laws. 


Abington. 




Colrain. 




Hancock. 


Agawam. 




Cummington. 




Hanover. 


Alford. 




Dartmouth. 




Hardwick. 


Ashfield. 




Deerfield. 




Harvard. 


Auburn. 




Dennis. 




Harwich. 


Bedford. 




Dighton. 




Hatfield. 


Berkley. 




Douglas. 




Hawley. 


Berlin. 




Dracut. 




Heath. 


Bernardston. 




Dudley. 




Hinsdale. 


Blackstone. 




Dunstable. 




Holbrook. 


Blandford. 




East Bridgewater. 


Holden. 


Bourne. 




Egremont. 




Holliston. 


Boxborough. 




Enfield. 




Hopedale. 


Boylston. 




Erving. 




Hubbardston. 


Brewster. 




Essex. 




Huntington. 


Brimfield. 




Florida. 




Kingston. 


Brookfield. 




Freetown. 




Lakeville. 


Burlington. 




Georgetown. 




Lanesborough. 


Carver. 




cm. 




Leicester. 


Charlton. 




Goshen. 




Leverett. 


Chatham. 




Granby. 




Ley den. 


Chelmsford. 




Granville. 




Lincoln. 


Cheshire. 




Greenwich. 




Longmeadow. 


Chester. 




Groveland. 




Lynnfield. 


Chesterfield. 




Hadley. 




Manchester. 


Clarksburg. 




Hampdei 


l. 




Mansfield. 



320 



Mashpee. 


Peru. 




Tisbury. 


Mattapoisett. 


Phillipstorj 


. 


Tolland. 


Medfield. 


Plainfield. 




Townsend. 


Mendon. 


Prescott. 




Truro. 


Merrimac. 


Raynham. 




Tyngsborough. 


Middlefield. 


Reading. 




Tyringham. 


Middleton. 


Rehoboth. 




Wales. 


Monroe. 


Richmond 




Warwick. 


Monterey. 


Rochester. 




Washington. 


Montgomery. 


Rockport. 




Wayland. 


Mount Washington. 


Royalston 




Webster. 


Nahant. 


Russell. 




Wellfleet. 


New Ashford. 


Sandisfielc 


L. 


WendeU. 


New Braintree. 


Savoy. 




West Bridgewater 


New Marlborough. 


Seekonk. 




West Brookfield. 


New Salem. . 


Sharon. 




West Newbury. 


Newbury. 


Sheffield. 




West Stockbridge. 


Norfolk. 


• Shelburne 




West Tisbury. 


North Andover. 


Shrewsbury. 


Westford. 


Northbridge. 


Shutesbury. 


Westhampton. 


Northfield. 


Southborough. 


Westminster. 


Oak Bluffs. 


Southwick 




Whately. 


Oakham. 


Sterling. 




Wilbraham. 


Otis. 


Stow. 




Windsor. 


Oxford. 


Swansea. 




Worthington. 


Pelham. 


Templeton. 


Wrentham. 


Pembroke. 


Tewksbury. 


Yarmouth. 


Section 16. Cities a 


nd Towns prom which no Information coi 




BE OBTAINED. 


Bolton. 




Paxton. 


Easton. 




Princeton. 


Gay Head. 




Sudbury. 


Littleton. 




Wenham. 


Millbury. 




Williar 


asburg. 



321 





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339 



Appendix G 



STATISTICS OF MILK TRANSPORTATION INTO BOSTON. 

Amount of Milk transported into Boston during 1906 (Quarts). 





Boston & 
Albany. 


Boston & 
Maine. 


New York, 

New Haven & 

Hartford. 


January 




1,332,604 


6,147,201 


1,857,863 


February, 
















1,205,300 


5,320,639 


1,699,607 


March, 
















1,536,120 


6,134,064 


1,837,624 


April, 
















1,587,060 


6,051,116 


1,902,188 


May, 
















1,769,768 


6,596,392 


1,876,023 


June, 
















1,759,177 


6,964,326 


1,913,221 


July, 
















1,695,886 


6,640,927 


1,724,948 


August, . 
















1,630,869 


6,372,150 


1,610,180 


September, 
















1,541,245 


6,369,436 


1,623,933 


October, . 
















1,524,968 


6,266,043 


1,688,887 


November, 
















1,383,409 


5,812,806 


1,598,172 


December, 
















1,382,567 


6,054,571 


1,638,630 




18,348,973 


74,729,671 


20,969,276 



Amount of Milk transported into Boston during 1907 (Quarts). 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



1,386,749 
1,239,827 
1,445,484 
1,472,430 
1,638,766 
1,691,241 
1,648,596 
1,452,650 
1,170,560 
1,333,905 
1,117,282 
1,174,929 
16,772,419 



6,211,815 
5,523,853 
6,248,497 
6,185,519 
6,425,503 
6,487,446 
6,669,955 
5,970,386 
5,574,826 
5,037,707 
5,087,587 
5,171,399 
70,594,493 



1,586,577 
1,516,558 
1,705,893 
1,828,261 
2,008,164 
2,080,381 
1,933,398 
1,807,663 
1,708,373 
1,821,845 
1,788,725 
1,817,197 
21,603,035 



340 



Amount of Milk transported into Boston during 1908 (Quarts). 



Boston & 
Albany. 



Boston & 
Maine. 



New York, 

New Haven < 

Hartford. 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



1,241,221 
1,178,499 
1,147,551 
1,328,558 
1,524,713 
1,541,900 
1,349,026 
1,299,259 
1,317,270 
1,318,707 
1,169,345 
1,246,882 



5,293,584 
4,925,676 
5,695,014 
5,254,103 
5,536,851 
5,857,026 
5,964,741 
5,785,903 
5,493,163 
5,347,172 
5,017,521 
5,316,584 



1,934,791 
1,822,678 
2,013,002 
1,987,127 
2,029,476 
1,985,393 
1,858,796 
1,817,954 
1,806,924 
1,984,437 
1,840,372 
1,927,122 



15,662,931 



65,487,338 



23,008,072 



Amount of Milk transported into Boston during 1909 (Quarts). 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



1,270,903 


5,033,372 


1,985,717 


1,154,657 


4,666,690 


1,985,717 


1,328,015 


5,161,949 


2,146,038 


1,394,808 


5,520,840 


2,130,839 


1,457,053 


6,273,596 


2,227,183 


1,436,432 


6,230,925 


2,308,070 


1,367,055 


5,925,875 


2,259,036 


1,229,491 


6,408,328 


2,166,728 


1,090,133 


5,202,991 


2,070,207 


1,295,629 


5,677,456 


2,322,280 


1,184,849 


5,496,995 


2,221,723 


1,239,835 


5,448,159 


2,376,820 


15,448,860 


67,047,176 


26,161,126 



341 



Amount of Milk transported into Boston during 1910 (Quarts). 



Boston & 
Albany. 



Boston & 
Maine. 



New York, 

New Haven & 

Hartford. 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



261,493 
129,956 
308,125 
,319,982 
278,791 
965,608 
165,639 
891,673 
904,062 
943,466 
799,828 
837,902 



5,271,660 

4,839,106 

5,475,064^ 

6,343,029 

5,218,864 

5,638,992 

5,599,752 

4,679,669 

4,444,055 

4,482,585 

3,938,947 

3,893,803 



2,511,295 
2,238,771 
2,528,599 
2,410,224 
2,388,932 
2,266,220 
2,411,087 
2,037,164 
1,881,451 
2,004,881 
1,962,578 
1,891,326 



11,806,525 



59,825,526^ 



26,532,528 



Amount of Milk transported into Boston during 1911 (Quarts). 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



954,991 

778,233 

947,997 

970,421 

1,000,904 

1,059,773 

814,939 

807,635 

794,337 

904,345 

1,042,719 

957,011 

11,033,305 



3,920,531 
3,810,408 
3,874,625 
4,162,647 
4,581,592 
4,742,762 
6,206,046 
5,138,598 
5,285,888 
5,492,557 
5,675,805 
5,684,134 
58,575,593 



1,943,600 
1,798,264 
2,005,974 
1,819,823 
2,007,567 
2,023,276 
1,702,749 
1,918,993 
1,910,729 
1,795,274 
1,578,739 
1,681,167 
22,186,155 



342 



Amount of Milk transported into Boston during 1918 (Quarts). 



Boston & 
Albany. 



Boston & 
Maine. 



New York, 

New Haven i 

Hartford. 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



699,099 

663,677 

778,999 

784,973 

999,002 

852,059 

1,323,508 

1,065,419 

1,044,702 

907,501 

1,114,468 

651,882 



5,640,697 
5,463,501 
5,959,732 
5,887,748 
5,926,088 
6,448,720 
6,389,101 
6,367,389 
6,622,503 
6,801,240 
6,534,098 
6,916,685 



1,746,433 
1,660,086 
1,798,682 
1,669,220 
1,630,478 
1,718,713 
1,468,410 
1,478,834 
1,446,076 
1,472,292 
1,354,856 
1,422,419 



10,885,289 



74,957,502 



18,866,499 



Amount of Milk transported into Boston during 1913 (Quarts). 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



429,311 
380,481 
444,513 
442,251 
500,943 
465,740 
451,915 
436,862 
490,677 
550,381 
586,978 
564,660 



5,744,712 



7,179,151 
6,693,732 
7,377,392 
7,438,618 
7,732,448 
7,520,704 
7,430,444 
6,820,345 
6,151,288 
5,913,873 
5,578,902 
6,290,180 
82,127,077 



1,446,881 
1,439,408 
1,546,405 
1,475,735 
1,748,368 
1,662,461 
1,725,201 
1,612,586 
1,550,894 
1,594,625 
1,505,290 
1,501,612 



18,809,526 



343 



Amount of Milk transported into Boston during 1914 (Quarts). 



January, . 

February, 

March, 

April, 

May, 

June, 

July, 

August, . 

September, 

October, . 

November, 

December, 



Boston & 
Albany. 



296,935 

288,116 

372,194 

393,512 

395,019 

445,397J^ 

395,257}£ 

506,954 

652,448 

306,271 

293,700 

584.223M 



4,930,027^ 



Boston & 
Maine. 



6,604,900 
6,043,261 
6,629,606 
6,373,612 
7,091,511 
7,471,728 
7,109,790 
6,717,219 
6,279,826 
6,349,448 
6,182,944 
6,427,270 



New York, 

New Haven i 

Hartford. 



79,281,115 



1,502,442 
1,475,780 
1,640,016 
1,829,712 
1,896,857 
1,906,124 
1,716,631 
1,498,746 
1,450,443 
1,539,926 
1,625,447 
1,743,196 



19,825,320 



344 



Appendix H 



REPLIES TO QUESTIONNAIRE RELATIVE TO LOCAL MILK 

INSPECTION. 

In April, 1915, a list of 18 questions was sent to local boards 
of health. These questions are as follows: — 

1. What is the amount of your appropriation for milk inspection? 

2. Have you a milk inspector? 

3. If so, how many milk licenses has he issued during the past year? 

4. What laboratory facilities have you for examining milk? 

5. How many chemical examinations of milk were made? 

6. How many bacteriological examinations of milk were made? 

7. How many permits were granted under chapter 744, Acts of 1914? 

8. How many permits were refused under chapter 744, Acts of 1914? 

9. How many licenses or permits were granted to owners of dairies of 

five cows or less? 

10. What is the total number of dairies in your town? 

11. What is the total number of dairy cows in your town? 

12. From how many different dairies does your town obtain its milk? 

13. How many dairies were inspected under chapter 744, Acts of 1914? 

14. In what cities or towns were these dairies located? 

15. Were any of these dairies inspected by the boards of health of any 

city or town other than your town? 

16. If so, how many? 

17. Were there any epidemics attributed to milk during the past year? 

18. Describe the nature of any such epidemic, the number of cases, and 

state whether or not it was investigated by a State Inspector of 
Health. 

Of the 353 cities and towns 72 made no reply up to September 
1. The replies from the balance have been carefully compiled, 
with the results stated below. 

Question 1 . — What is the amount of your appropriation for milk 
inspection? 

No answer, 72 

No appropriation, • 196 

Appropriation not specified, . . .22 

Specific appropriation, 63 



345 



The specific appropriations are distributed as follows: — 



Less than 
Between $100 and 
Between $500 and $1,000, 
Between $1,000 and $2,000, 
Between $2,000 and $2,500, 
Between $3,000 and $4,600, 



16 
24 
9 
6 
5 
4 



The cities and towns stating that the appropriation was not 
specified are as follows: Amherst, Attleboro, Belmont, Boston, 
Chicopee, Dalton, East Bridgewater, Framingham, Gloucester,' 
Great Barrington, Greenfield, Lancaster, Ludlow, Lynn, Marble- 
head, Medway, New Bedford, Orange, Palmer, Petersham, 
Wellesley and Weston. 

Most of these localities spent but little money upon milk in- 
spection, but the following cities maintain good laboratories for 
several employees, and spend a large amount of money per 
annum for this proposition: Boston, Lynn and New Bedford. 

The following cities and towns have specific appropriations; 
those in italics spend more than $1,000 per annum: Adams' 
Andover, Arlington, Barnstable, Beverly, Blackstone, Braintree' 
Brockton, Brookline, Cambridge, Canton, Chelsea, Clinton, Co- 
hasset, Concord, Danvers, Dedham, East Longmeadow, Everett 
Fall River, Fitchburg, Gardner, Gosnold, Haverhill, Holyoke, 
Hudson, Hull, Ipswich, Lawrence, Lowell, Marlborough, Melrose 
Middleborough, Milton, Montague,, Natick, Needham, Newton,' 
North Adams, North Attleborough, North Brookfield, North- 
ampton, Rowe, Salem, Saugus, Scituate, Somerville, Springfield, 
Taunton, Walpole, Waltham, Ware, Wareham, Warren, Water- 
town, West Brookfield, Westborough, Winchendon, Winchester, 
Winthrop, Woburn and Worcester. 

Question 2. — Have you a milk inspector? 



No replies, 
Yes, . 
No, 



72 
115 
166 

353 



The following cities and towns from which no reply was 
received are known to have milk inspectors: Lexington, Maiden, 
Medford, Newburyport, Pittsfield, Quincy, Revere. Westfield 



346 



Question 3. — If so, how many milk licenses has he issued during the 
past year? 

No reply, . 72 

None, ...... . . . ' 177 

Balance, 104 

Total licenses issued, 16,521 

The total licenses issued throughout the State are, of course, 
much greater than this, as each town and city having a milk 
inspector failing to reply to this questionnaire issued more or 
less licenses. The total number of licenses is probably 1,200 to 
1,500 more. 

The number of licenses per town are distributed as follows: — 



Between 1 and 


25, 


Between 25 and 


50, 


Between 50 and 


100, 


Between 100 and 


200, 


Between 200 and 


400, 


Between 400 and 


800, 


Between 800 and 1,600, 


5,381, . 





33 

27 
19 
9 
4 
9 
1 
1 



103 



Of these 103 cities and towns 79, or 76.7 per cent., issued less 
than 100 licenses, total number of licenses being 2,603; 24, or 
23.3 per cent, of these cities and towns issued more than 100 
licenses per town, the total number of licenses being 13,918. 
The average number of licenses was 158. In those issuing less 
than 100 licenses the average number was 33; in those issuing 
more than 100 licenses, the average number issued was 681. 

Question 4- — What laboratory facilities have you for examining milk? 



No reply, 
None, . 
Balance, 



72 
235 

46 

353 



Chemical and bacteriological apparatus complete, 

Babcock machine, . . . 

Babcock, lactometer and bacteriological outfit, . 



18 
11 

4 



347 



Babcock and bacteriological outfit, 

Babcock, sediment tester and bacteriological outfit, 

Chemical laboratory, 

Babcock and lactometer, 

Babcock and sediment tester, . 

Sediment tester, 



46 

Some localities send samples to commercial chemists or to 
other milk inspectors. With but few exceptions the outfits are 
meager. 

Question 5. — How many chemical examinations of milk were made? 



No reply, 


















72 


None, . 








. 222 


Balance, 








. 59 
353 


Between 


1 and 


25 analyses, 




6 


Between 


25 and 


50 analyses, 












7 


Between 


50 and 


100 analyses, 












9 


Between 


100 and 


200 analyses, 












5 


Between 


200 and 


400 analyses, 












15 


Between 


400 and 


800 analyses, 












8 


Between 


800 and 


1,600 analyses, 












3 


Between 1,600 and 


3,200 analyses, 












5 


Between 3,200 and 


6,400 analyses, 












- 


Between 6,400 and 12,800 analyses, 












- 


15,150, . 
















1 






T 


owns. 


Total 

Analyses. 


Average per 
Town. 


Reports of analyses, . 




59 


41,370 


700 


Less than 100 


analyses, 




22 


748 


36 


Between 100 and 1,000 analyses 


27 


10,586 


335 


Between 1,000 and 15,150 analyses, .... 


8 


29,848 


3,731 


Between 1,000 and 2,697 analyses, .... 


7 


14,698 


2,100 



In nearly all places where less than 100 analyses were made 
during the year the only determination made was the fat and 
possibly the specific gravity. 



348 



Question 6. 
made? 



No reply, 
None, . 
Balance, 



How many bacteriological examinations of milk were 



72 

237 

44 

353 



Between 
Between 
Between 
Between 
Between 
Between 
Between 
Between 
Between 
6,834, . 



1 and 

25 and 

50 and 

100 and 

200 and 

400 and 

800 and 

1,600 and 

3,200 and 



25 analyses, 

50 analyses, 

100 analyses, 

200 analyses, 

400 analyses, 

800 analyses, 

1,600 analyses, 

3,200 analyses, 

6,400 analyses, 





Towns. 


Total 
Analyses. 


Average per 
Town. 


Reports of analyses, ....... 


44 


21,532 


490 


Less than 100 analyses, ...... 


20 


854 


43 


Between 100 and 1,000 analyses 


19 


10,586 


555 


Between 1,000 and 6,834 analyses 


5 


14,324 


2,865 


Between 1,000 and 2,286 analyses 


4 


7,490 


1,872 



11 places make chemical but not bacteriological examinations. 
4 places make bacteriological but not chemical examinations. 



Question 7. 
Acts of 1914? 



How many permits were granted under chapter 744, 



The answer to this question shows that with but few exceptions 
practically no action was taken under this statute. This was 
attributed in many instances to the prevalence of the hoof and 
mouth disease, whereby inspections of tho dairies was rendered 
impossible, but it was disregarded more often by reason of the 
expense which would have occurred, possibly through lack of 
appropriations and possibly because it would be considered poor 
policy to spend the money required to carry out the provision 
of the act. Furthermore, many cities and towns rely to a large 
extent upon the inspection made by other cities in their neighbor- 



349 



hood when the milk supply to all these localities comes from a 
common source. 

No reply, . 72 

None, . ... .''.'-. . . 223 

Balance, 58 1 



353 



Of these localities — 
31 issued less than 25 permits. 
15 issued from 25 to 50 permits. 
10 issued from 50 to 100 permits. 

1 issued 132 permits. 

1 issued 285 permits. 
The total permits were 1,840, an average per place of 32. 

Of those 12 localities issuing more than 50 permits 1,103 were 
issued with an average of 93 permits per locality. Of the 46 
towns issuing less than 50 permits per town, 417 permits were 
issued, averaging 9 permits per town. The town reporting the 
issuing of 132 permits had inspected only 45 dairies. The law 
under which these permits are issued requires that they shall be 
issued only after an inspection of the premises and the conditions 
under which the milk is produced. 

Question 8. — How many permits were refused under chapter 744, 
Acts of 1914? 



Eighteen localities refused 53 permits, as follows: — 



Needham, . 
Edgartown, 
Fitchburg, . 
Newton, 
Winchester, 



Duxbury, . 


. 14 


Brookline, . 


. 6 


Natick, 


. 5 


Plymouth, . 


. 4 


Dedham, 


. 3 


Lynn, . 


. 3 



Chicopee, Dalton, Pepperell, Southbridge, Spencer, Winchester and 
Yarmouth 1 each. 

Question 9. — How many licenses or permits were granted to owners 
of dairies of 5 cows or less? 

After the answers to this question had been compiled it was 
discovered that there was a misunderstanding in the meaning of 



1 Issued permits. 



350 

the question. It was the intention to obtain the number of 
dairies having only 5 cows or less and not buying milk from 
other people. The answers given included many dealers who 
were in the milk business and in addition owned a few cows. 

Question 10. — What is the total number of dairies in your town? 
Question 11. — What is the total number of dairy cows in your town? 

The answers to these two questions were not compiled because 
so many rural towns made no reply. Unfortunately this informa- 
tion was greatly desired by the Milk Board in order to ascertain 
the number of dairies and dairy cows in the State, and in order 
to assist it in choosing localities for visiting. Many of these 
towns making no replies, as has been since ascertained, did so 
by reason of the fact that they carried on no inspection work, 
and were of the opinion that a reply would be of no value to the 
Department. 

Question 12. — From how many different dairies does your town 
obtain its milk? 

The answers to this question when first compiled gave a total 
of 54,000 dairies, but there was undoubtedly considerable dupli- 
cation in the figures, and this was' still further made apparent 
after the answers to question 13 were compiled. For this reason 
a second compilation was made for the purpose of carefully 
avoiding any duplication. The number of dairies reported by the 
city of Boston were used as representing the combined dairies 
supplying Boston, Cambridge, Somerville, Chelsea and the other 
cities surrounding Boston, and, in short, an attempt was made to 
count the dairies of the large contractors but once. This idea 
was carried through the entire list, and the second compilation 
gave 17,284 as the total number of dairies supplying the State, 
of which 8,700 do not furnish milk to Boston and vicinity. These 
figures are not by any means accurate, but are as close an 
approximation as can be made from the returns given. Un- 
doubtedly the dairy figures are somewhat low. 

Question IS. — How many dairies were inspected under chapter 744, 
Acts of 1914? 

The first compilation of the answer to this question showed 
that but 7 per cent, of the dairies supplying milk to Massa- 
chusetts have been inspected. These figures were again compiled 



351 

for the reason described above, and on the second compilation 
the total dairies inspected were estimated to be 10,318, about 
3,000 of which were inspected by cities and towns other than 
Boston, the city of Boston inspecting nearly all the dairies from 
which its milk supply is obtained. 

Question 14. — ■ In what cities or towns were these dairies located? 

The responses to this* question show that with the exception 
of a few large cities and towns the dairy inspection was confined 
to local dairies, the Inspection Department making no attempt 
to go out of town for the purpose of inspecting dairies from 
which the town received its milk. 

Question 15. — Were any of these dairies inspected by the boards of 
health of any city or town other than your town? 
Question 16. — If so, how many? 

These questions were introduced for the purpose of ascertain- 
ing how much actual duplication of milk inspection existed in 
this State. A study of the law would certainly convince one 
that at least one-half of the dairies supplying milk to the cities 
and towns in this State should have been inspected by the 
boards of health of from 3 to 10 different cities and towns. 
The compilation of the answers has shown that there was but 
little duplication of inspection, notwithstanding the fact that 
many towns replied yes to question 15. In these cases, however, 
nearly all the milk raised was shipped out of town, and the 
entire inspection made under these conditions was naturally 
made by the board of health of the town where the milk was 
sold, and not the town where the milk was produced, and 
furthermore, in nearly all these casets the local boards of health 
made no inspection whatsoever. Owing to the fact that except 
in the case of the largest cities practically no inspection of 
foreign dairies is made, the duplication of inspection which one 
would expect to occur is lacking. Furthermore, communities 
rely to a large measure on the inspection of other cities and 
towns to safeguard their own milk supply. For example, Revere, 
Chelsea, Winthrop and Melrose make no attempt to inspect the 
premises of the producers supplying the large contractors, but 
depend upon the inspection made by the city of Boston. In a 
similar manner the town of Methuen depends almost entirely 
upon the inspection made by the city of Lawrence, because the 
milk supply of both places comes, practically, from the same 



352 

source. One town replied that they made no inspection at all, 
but depended upon those made by the State Board of Health. 
The town of Brookline reports that the city of Boston inspected 
nearly two-thirds of the dairies inspected by Brookline. Newton 
has inspected many of the dairies inspected by Boston and 
Brookline. The city of Somerville has duplicated some of the 
Boston work. No doubt all the cities and towns receiving 
nearly their entire supply from the large contractors could have 
made the same report if they had carried out the provisions of 
chapter 744 of the Acts of 1914. 

Question 17. — Were there any epidemics attributed to milk during 
the past year? 

Question 18. — Describe the nature of any such epidemic, the number 
of cases, and state whether or not it was investigated by a State Inspector 
of Health. 

Mansfield. — Typhoid fever in August, September and October, 29 
cases. Typhoid fever in March and April, 1915, 21 cases. Investigated 
by Dr. McKnight of Fall River and Dr. Kelley of Boston. Dr. Kelley 
and Miss Beckler know all the conditions of affairs in these two epi- 
demics. 

Natick. — One place where scarlet fever was found and one dairy 
where there was a case of typhoid was investigated by the State In- 
spector besides our Board and Dairy Inspector on our request. 

Weymouth. — Twenty-six cases of typhoid fever on one milk supply. 
No deaths. Investigated by the State Board of Health. 

Beverly. — One epidemic; the milk from New Hampshire dairy dis- 
continued. Investigated same and discontinued milk supply coming 
to Beverly. The disease was typhoid fever. The State Inspector visited 
Beverly a number of times. 

Boston. — Two epidemics, septic sore throats. First outbreak in 
Dorchester, 295 cases; second outbreak, 275. Investigated by Dr. 
Champion. 

Brookline. — One epidemic of septic sore throat, — about 20 cases. 
Not investigated by State Inspector of Health. Such drastic action was 
taken that the milk dealer immediately went out of the milk business. 

Leominster. — There was one typhoid fever epidemic with 12 cases 
which was investigated by Dr. Louis Fish of Fitchburg. 

North Adams. — One epidemic of typhoid fever. Something like 50 
cases were investigated by Dr. Lyman Asa Jones. 

New Bedford. — Two epidemics which might have been due to milk. 
Inspected by local authorities and precautions taken. 

Shirley. — Three cases of scarlet fever investigated by Dr. Simpson. 

Winthrop. — Several cases of septic sore throat reported from one 
dealer. To^ samples of milk and went to State House. Story told to 



ae 
n. 
le 
3i. 
id 
id 
ie 
dl 
Id 
To 
>s. 
to 
35 



ale- 



Appendix I 




Map Showing 
Milk Producing Sections 
Investigated 



The Milk Board 

OF" THE 

Mass. State Dept. of Health 
1915 



(§) BLACK CIRCLES DENOTE SECTIONS VISITED. 






source. C 
but depen 
The town 
nearly tw< 
has inspe 
Brookline. 
Boston w 
nearly th< 
made the 
chapter 7 

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cases. T; 
by Dr. IV. 
and Miss 
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where th 
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353 

Dr. Hanson; 26 cases of septic sore throat; made notes, and sent me 
to Harvard Medical, Longwood Avenue, for test. Saw Mr. Brown. 
Said I .could not get results of test until Monday. Took one of the 
samples to biochemical laboratory and got results at 3. Streptococci. 
Closed down the dairy, came back and took samples of all the cows and 
checked all up. At 9 p.m. we had the 3 infected ones found; also found 
that there were 59 cases in town. The State Inspectors were here the 
next day, at 2 p.m., and looked over the ground, and Dr. Linenthall 
sent the Board a letter telling them what was necessary before he could 
open again, etc. There were 126 cases all told of this sore throat. No 
milk has ever been sold by this man since, and he went out of business. 
It was the best thing that ever happened, as it was a lever for me to 
bring every one to their senses as to the conditions. We did have 35 
cows all told in town, from 2 to 14 in herds; to-day we have none. 



354 



Appendix J 



BIBLIOGRAPHY. 

Reports of the Massachusetts State Board of Health 1890-1913. 

Records and files of the Massachusetts State Board of Health. 

Practical Hygiene, Harrington and Richardson. 

The Milk Question, Rosenau. . 

Preventive Medicine and Hygiene, Rosenau. 

Pediatrics, Rotch. 

Transactions of the American Association for Study and Prevention of 
Infant Mortality, 1910, 11, 12, 13, 14. . 

Chemie der menschlichen Nahrungs und Genussmittel, Dr. J. Konig, 
fourth edition. 

Journal of Hygiene, Vols. 2 and 6. 

Infant Mortality, G. Newman. 

Reports of Boston Health Department. 

Reports of the English Royal Commission on Human and Animal Tuber- 
culosis. 

Various Bulletins, United States Department of Agriculture. 

Various Bulletins, United States Public Health Service. 

Various Bulletins, New York City Department of Health. 

Typhoid Fever, George C. Whipple. 

Transactions of the Sixth International Congress on Tuberculosis. 

Transactions of the Seventh Annual Meeting of the National Associa- 
tion for the Study and Prevention of Tuberculosis. 

Transactions of Federation Internationale de Laiterie, 1905. 

Bacteriology of Milk, Swithinbank and Newman. 

The Commonsense of the Milk Question, Spargo. 

The Carrier Problem in Infectious Diseases, Lodingham and Arkwright. 

Sources and Modes of Infection, Chapin. 

The Business of Dairying, C. B. Lane. 

Report of Milk Investigation by Chamber of Commerce, Boston. 

Bovine Tuberculosis and its Control, Moore. 

Modern Medicine, Osier. 

Acute Contagious Diseases, Welch and Schamberg. 

Laws of Massachusetts. 

Proposed Massachusetts Laws. 

Report Seattle Department of Health and Sanitation, 1912, 13, 14. 

Journal of the Royal Sanitary Institute (files). 

American Journal of Public Health (files). 



355 

Collected Studies from the Bureau of Laboratories of the New York 

City Department of Health, Park. 
Report of Committee of One Hundred on National Vitality. 
Milk and its Relation to the Public Health, Savage. 
Files of the Reports of the United States Public Health Service from 

1908-15. 
Reports of Federal Census of 1900 and 1910. 
Agricultural Year Books, United States Department of Agriculture 

(various years, 1900-12). 
Special Reports of United States Public Health Service: — 
"Milk and its Relation to the Public Health." 
Bulletin No. 51, Hygienic Laboratory of the United States Public 

Health and Marine Hospital Service. 
Reports on the Origin and Prevalence of Typhoid Fever in the District 

of Columbia. 
Bulletins Nos. 35, 44, 52 and 78 of the Hygienic Laboratory, United 

States Public Health and Marine Hospital Service. 
Reports of the State Board of Agriculture of Massachusetts. 
"Infectiousness of Milk," published by Massachusetts Society for 
Promotion of Agriculture (report by Dr. Harold C. Ernst). 
Massachusetts Census Reports. 
Massachusetts Polls and Taxes. 
Massachusetts Public Service Commission Reports. 
Massachusetts Agricultural College Publications. 
Reports of Boston Chamber of Commerce Statistics Department. 
Cattle Feeding, Ormsby. 
Files of — 
Hoard's Dairyman. 

Berkshire World (devoted partly to Jersey cattle interests). 
Rural New Yorker. 
New England Homestead. 
Country Gentleman. 
Study of Breeds, Shaw. 

Massachusetts Department of Animal Industry Reports. 
Bureau of Markets, Statistics. 
Massachusetts State Grange Reports. 

Agricultural Reports of Various States and Dominion of Canada. 
Statements by letter from ■ — ■ 
Cattle Associations. 
Milk and Baby Hygiene Associations. 
Catalogues ef Milk Utensils and Appliances. 
Dairymen on Cost of producing Milk. 
Records of Legislative Committee on Milk, 1911. 



356 



Appendix K 



LIST OF CONFERENCES AND MEETINGS ATTENDED OR 
OF PERSONS INTERVIEWED RELATIVE TO THE MILK 
QUESTION. 

Massachusetts State Grange Executive Committee Meetings. 

New England Holstein-Friesian Cattle Breeders' Association Meeting. 

Massachusetts Milk Inspectors Association Meeting. 

Legislative Hearings. 

Meeting at Century Club (Dr. North's Lecture). 

Field Meetings of Massachusetts State Grange (25), and interviews 
with many persons at these meetings. 

Dairymen interviewed in Massachusetts, Vermont. New Hampshire and 
Province of Quebec while on inspection trips (probably 150 to 200). 

Hon. Wilfrid Wheeler, Secretary, State Board of Agriculture. 

Dr. L. 0. Howard, Commissioner, Massachusetts Department of Animal 
Industry. 

P. M. Harwood, Agent, State Dairy Bureau. 

Hon. Chas. M. Gardner, Past Master, Massachusetts State Grange, Chair- 
man, State Dairy Bureau. 

Mr. Tinkham of the Rhode Island Inquiry Board. 

Dr. Stone, Massachusetts State Board of Insanity. 

Dr. Frank Woods (Holyoke) on value of fresh milk for babies. 

Dr. Mark W. Richardson on value of fresh milk for babies. 

Members of the Massachusetts State Board of Agriculture. 

J. L. Ellsworth, Past Secretary, Massachusetts State Board of Agri- 
culture. 

Mr. Sacker, President, New England Cattle Dealers' Association. 

Various dealers in milch cows at Brighton. 

Dr. Davis (Hood & Co., Charlestown plant). 

Mr. Park (Hood & Co., Lynn plant). 

Mr. Whiting (Whiting's plant in Charlestown). 

Mr. Blossom (Hood Agent, North Hatley, Que.). 

Mr. Lamson (United States Dept. of Agriculture, Bureau of Chemistry, 
North Hatley, Que.). 

Mr. Myron T. Pierce (Attorney, Milk Consumers' League). 

Mr. J. C. Orcutt (Assistant Secretary, Boston Chamber of Commerce). 

Westport, Maine, Agricultural Fair. 

Segreganset Agricultural School. 

Essex County Agricultural School. 



357 

Mr. Lombard, Inspector, Massachusetts State Board of Agriculture 

Dairy Bureau. 
Mr. J. F. Bresnahan, Milk Inspector, Fitchburg. 
Mr. G. A. Flanagan, Milk Inspector, Lynn. 
Dr. Stanbridge, Milk Inspector, Winchendon. 

Dr. P. H. Mullowney, Department Commissioner^ Boston Health De- 
partment. 
Dr. Thos. E. Maloney, Board of Health, Fall River. 
Mr. W. E. Ward, Milk Inspector, Brookline. 
Mr. A. W. Russell, Agent, Board of Health, Newton. 
Mr. Geo. Barrow, Milk dealer, Waltham. 
Mr. Childs, Milk dealer, Waltham. 

Dr. H. W. Pierce, Massachusetts State Department of Animal Industry. 
Dr. MiUiken, Chairman, Barnstable Board of Health. 
Mr. Mecarta, Milk Inspector, Barnstable Board of Health. 
Mr. John Cook, Chairman, Provincetown Board of Health. 
Mr. G. L. Berg, Milk Inspector, Worcester. 
Mr. H. E. Bowman, Milk Inspector, Somerville. 
Dr. F. G. Curtis, Chairman, Newton Board of Health. 
Various officials of the New York City Health Department, including 
the Commissioner of Health, the Chief of the Division of Foods, the 
Chief of the Division of Milk Inspection, the Chief and the Epidemi- 
ologist of the Bureau of Infectious Diseases. 
Convention of Certified Milk Producers' Association at Atlantic Citv, 

N. J. 
Convention of International Milk Inspectors' Association at Washington. 
Convention of Official Agricultural Chemists, Washington. 
Convention of the American Public Health Association, Rochester, N. Y. 
Plant of the George M. Oyster Milk Company, Washington, D. C. 
Plant of the Borden Condensed Milk Company, New York City. 
Plant of Slawson Decker-Sheffield Farms Company, New York City. 
Plants of H. P. Hood & Sons at Boston and Lynn, Mass., Newport, Vt., 

and Unity, Me. 
Plants of D. Whiting & Sons, Boston, Mass., Thorndike, Newbury, 

./Etna and Pittsfield, Me. 
Plants of C. Brigham Company, Cambridge. 
Plants of the Turner Centre Dairying Association at Auburn, Benton, 

Wiscasset and Unity, Me. 
Dr. Fred Meader, Chief of Division of Communicable Diseases of the ' 

New York State Health Department at Albany. 
Dr. Herman Biggs, New York State Commissioner of Health, New York 

City. 
Dr. A. J. Chesley, Chief, Division of Preventable Diseases, Minnesota 

Board of Health, at Rochester. 
Assistant Surgeon General J. W. Trask, United States Public Health 
Service, at Rochester. 



358 

Hon. W. T. Guptill, State Commissioner of Agriculture, A. M. G. Soule, 
Chief of Bureau of Inspection, and Mr. J. H. Blanchard, State Dairy 
Instructor, all of the Department of Agriculture of Maine. 

Dr. Ivan C. Weld, Secretary, International Milk Inspectors' Association. 

Mr. Julius Hortvet, State Chemist, Minnesota, and member of the 
Joint Committee on Standards, United States Department of Agri- 
culture. 

Mr. Jones, Associate Chief, Bureau of Chemistry, United States Depart- 
ment of Agriculture. 

Hon. F. A. Stadtmueller, Dairy and Food Commissioner of Connecticut. 

Dr. Charles V. Chapin, Superintendent of Health, Providence, R. I. 

E. L. Bradford, Manager, Turner Centre Dairying Association, and 
many others. 



